Hi everyone, Im very confused about what is going on with my insurance. I went to the doctors a lot this year because of a lot of health issues and most of my claims were denied except for 2 for which I need to pay $20 each on those. The claims that were denied says that my estimated costs was $0 and that it wasn’t health plan paid but the health plan discount took care of it. Does that mean that I don’t owe anything at all? Should I get in contact with my insurance and see if I need to get it approved. Idk what to do and I don’t have much time left with my insurance as I am aging out of it as its my parents insurance and I am a dependent on it.
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First, are the providers in network?
What is the reason listed on the EOB for the denial?
If the providers are in network then you go by the EOB.
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The providers were all in network and the EOB didn’t say why it was denied. It just showed the amounts
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Something is not adding up, by law they have to list a reason on the EOB for the reason something is denied, I would give them a call and ask them.
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Okay, some of them are months old but I will ask about those as well. I know it says my estimated costs is $0 but I would have liked to know why it was denied. Thank you
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There should be a patient owes to provider amount on the EOB. Look at that amount.
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It doesn’t show what I owe the provider for the denied claims. It only shows the total provider charges, the amount the health plan paid, the health plan discount, and my estimated costs. If my estimated costs are listed, it says $0 for me.
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If the providers are in-network, they must follow the EOB. It’s possible you owe nothing, and the provider covers the full cost. This usually happens when insurance denies the claim because of something the provider did wrong, like not submitting the claim on time or missing pre-authorization. There should be a code explaining the reason.
As long as the patient’s responsibility shows $0, it’s not your issue. The provider might appeal, and if they do, you’ll get an updated EOB later.
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