The Pulse of SchoolCare, May 2022

Why You Should Regularly Review Your Explanation of Benefits

Published May 12, 2022

An important component of managing your health care throughout the year is ensuring you are paying what you expect for the services you receive. The easiest way to do this is to review your explanation of benefits (EOB) following any medical appointments.

Your EOBs are available in your MyCigna portal once your claim has been processed. They may also be mailed to your home in advance of receiving a bill.

Two Reasons to Review Every EOB You Receive.

  1. To verify your medical provider correctly reported the treatment you received
  2. To ensure your coverage was accurately applied to the medical services rendered

In recent months, SchoolCare has been contacted by two plan participants who received bills for care they had not received. In one case, the wrong procedure was billed while in another case, the participant received a bill for care provided at a facility in a state they’ve never been to. Both examples were the result of human error, an incorrect billing code and a mistyped subscriber number. While rare, these mistakes do happen on occasion and are easier to work out when caught early.

What Information Does Your EOB Provide?

Your EOB provides details pertaining to which provider you saw, where and when, and what services were received.

Your EOB also breaks down the full cost of the service, any discounts negotiated by the insurer, what portion of the service was covered by your plan and the balance you are expected to pay. This helps you know what you should expect to receive a bill for, and you should always then ensure when you receive your bill that it in fact matches your EOB.

What To Do If You Believe Your EOB or Resulting Bill is Inaccurate

If your EOB has inaccurate information on it – whether it’s pertaining to the care received or the amount it indicates you will be billed for, your first course of action should be to call the phone number on your statement to talk with a customer service representative. Usually, this conversation can resolve the problem quickly. If the issue was not resolved satisfactorily, you always have the right to appeal. Please review the appeal information printed at the bottom of every EOB. Catching mistakes early can help ease the process of resolving them before a bill is issued

While reaching out to Cigna should be your first step with billing or claims questions, SchoolCare is always here to provide additional support as needed.

Cigna: 800-244-6224 24/7/365

SchoolCare: 603-836-5031 or info@schoolcare.org

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