Patient or Guarantor medical histories provided to hospitals for billing purposes usually contain details regarding diagnoses or procedures performed, person responsible for payment (ie Patient or Guarantor), as well as insurance provider contact details.
Some insurers require family medical histories on proposal forms for health and life insurance, in order to assess your risk and eligibility for coverage.
Medical Records
Medical records of an insured are an integral component of underwriting procedures in insurance. Their comprehensive medical history should include all past illnesses and treatments for various conditions as well as surgery records that provide insight into whether an applicant can be approved for an insurance policy and to establish their coverage and premium costs.
Under HIPAA, individuals have a right to access all information held about them in medical or personal health records maintained by covered entities; however, there may be certain circumstances under which an individual cannot see his/her entire record; examples may include:
When amending an electronic medical record, it is best to strike through rather than delete and overwrite. This reduces the chance of any tampering with it; if corrections must be made, insert new notes with date and doctor name [1]. This applies equally well for paper records.
Billing Statements
Billing statements are financial documents issued by service providers or sellers to customers or buyers that detail goods and services offered, their charges, taxes, fees and total amount due for payment. These bills also often include terms and conditions.
Medical bills, or statements issued from healthcare providers to patients, provide an account of an insured’s comprehensive health history including diagnoses, procedures and treatments received over time. They are frequently used during underwriting procedures when applying for insurance coverage.
As part of their registration or check-in procedure, medical offices typically ask patients for their insurance details in order to verify it and ensure all eligible patients can access care while also giving billing departments enough information about each claim to accurately process them. This practice ensures all patients can access care while also helping to facilitate accurate processing by billing departments of any insurance claims submitted for processing.
When receiving their medical billing statement, patients can expect to see several key elements:
An Account Number – Each healthcare provider assigns you with an Account Number which should appear on all bills as a way to identify it and contact them if any questions arise regarding charges on them. This number should also serve as your reminder if any additional assistance is required regarding them.
Service Dates – These dates refer to when services were performed on you, whether that means multiple dates for hospital stays or services occurring over multiple days. It is essential to carefully examine these dates as many healthcare providers will charge extra fees for procedures not covered by insurance (referred to as non-covered services).
Health care providers charge fees based on their fee schedules for various services they provide, from primary care physician visits and ambulance fees to ambulance fees and equipment rental costs. Your health insurance may also cover some or all drugs on this list depending on their effectiveness, safety and cost-effectiveness; these could be both prescription drugs and over-the-counter alternatives.
Health care providers typically pay their insurance company the amounts related to an approved claim for medical coverage, which may include any applicable deductible or co-insurance payments that the patient is responsible for paying.
Explanation of Benefits
An explanation of benefits, or EOB, is sent by your insurance company when your health care provider files a claim on your behalf and contains details regarding what services your plan covers and how the cost will be divided among you and them. Although not billed directly, EOBs should be understood so as to ensure you pay the correct amount. It’s essential to fully comprehend all information provided so you know you’re being charged correctly for services received.
An EOB typically includes the patient’s name and ID number, the service date (for outpatient visits), reason for visit, medical code used and amount billed by provider; any copayment or deductible amounts due are also listed; additionally it will indicate how much of annual deductible has been met if applicable.
An EOB should include your claim number, which should correspond with that on your health insurance card. In addition, the document usually provides contact numbers of insurance providers as well as access to online portals where you can track its status.
EOBs typically arrive a few days after healthcare providers file claims on your behalf. If your provider also holds your insurance account, the healthcare provider can submit it on your behalf, speeding up the process considerably; in other cases however, claims must be sent directly to your insurer, and may take longer.
EOBs should not be confused with the Summary of Benefits and Coverage document that provides an overall snapshot of your coverage options. If you need assistance understanding these documents, consult a professional to make sure that any payments for services already covered under your plan don’t come out of pocket.
EOBs
An EOB (Explanation of Benefits) is one of the key documents in understanding your medical history. Your insurance provider sends it after filing a claim; usually via email. An EOB does not replace medical bills from providers but instead gives a detailed account of what was charged, what portion was covered by health care plans, and any remaining balance that you may owe.
An EOB provides a summary of charges from your healthcare provider, such as service description, diagnosis code, procedure code and tax ID number. Next comes information about what insurance covered as well as any portion that needs to be paid by you (copay or deductible). Lastly comes an explanation for charges not covered such as out of network charges or policy exclusions that were not covered or paid – for instance it might indicate why they weren’t covered such as being outside your network or being excluded under your policy.
If there is a significant delay between you receiving an EOB and receiving your actual bill from healthcare provider, it may be worth double-checking that all details of your visit are accurate. Call both your insurance company and healthcare provider to make sure dates, descriptions and codes match up; for added peace of mind it would also be wise to keep both documents together as backup should there be discrepancies.
Recent market conduct examinations revealed that certain insurers are failing to issue EOBs for fully or partially denied claims as required under New York insurance law, denying patients from knowing whether their health care coverage covers all services received. If you think your healthcare insurer is failing to deliver timely or clear explanation of benefits for services received, make contact immediately with them immediately.