Checklist of Essentials

Bill

It is a foregone conclusion that you have received a bill and are now beginning the process of validating what you may owe.

This may reflect terms such as “Bill”, “Statement”, “Billing Statement”, “Invoice” or others. Importantly it should, at a minimum, reflect the identity of the provider of the services being billed for.

Explanation of Benefits (EOB)

If you have insurance, you should have a record of the claim that was processed by your insurance.

It is important to match this to your bill.

Be sure to reconcile any financial transactions reflected on both the bill and the EOB and confirm they are consistent. Financial transactions are not limited to payments. They may include “adjustments”, “withholds””, “penalties”, as well as “Co-Pay” or “Co-Insurance” amounts.

Coverage Details

You should be familiar with the terms of your coverage. Your coverage details are required to be provided to you when coverage begins or changes as well as at your request at any time.

It is important to be sure that you are in possession of the complete contractual terms and not simply a “summary”.

Documents

You should always be sure to secure copies of any and all documents that you may have signed. Often, in the midst of seeking healthcare (especially under urgent circumstances) there may be an overwhelming amount of documents. These may range from Privacy to Clinical Consents and Risk Advisaries as well as Financial Terms and Contracts.

* Referrals, Authorizations, Prescriptions

Be sure to maintain copies of any documents such as referral forms, pre-authorizations for services, prescriptions (not always limited to medications but may be used for supplies and other care services and items as well).