The EOB is what the insurance company is paying the provider for the services billed. But often there is something that needs to be resubmitted by the drs office or hospital to the insurance company for reprocessing before they bill the patient for the final amount the patient is responsible for. A common mistake (“mistake”) is that they might only pay for one unit of something billed when it was billed for several units.
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H’s Prevnar vaccine payment was denied by Medicare, so I did some investigating myself. The doctor’s office used the wrong code for the administration of the shot. I told H not to pay any bill that comes his way (Medicare noted that patient responsibility is 0), but so far he has not been billed. I assume that the billing department figured out the issue and resubmitted, but I guess we’ll eventually know. My H doesn’t worry about stuff like that, so I get to obsess until I know it’s all good!
And as far as it taking a long time to see a doctor bill, it once took over a year for a doctors office (urgent care) to send us a bill. And that one also didn’t go through correctly. They didn’t recognize it as in-network even though my insurance company EOB said it was. I appealed twice before getting our rep involved, but it only took once after she talked to them.
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Since I started Medicare, I now have small checks sent to me for care I receive from my out of state providers. They get most of their payment from Medicare, but the portion my insurers normally pays directly to provider is sent in a check directly to me (20% of eligible amount). I have not been billed for these amounts and mychart says I owe nothing. Some of these payments are for services rendered 9/2023!
Insurer said just cash the checks and wait to be billed before making payment. It still feels very odd, but it makes sense to wait for a bill. I made a spreadsheet of all the checks and dates of service. It’s not a huge amount but still feels odd. If I didn’t cash the checks they would have gotten stale and would require insurer to re-issue.
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My annual visit to my PCP last September has not shown up in billing or insurance yet. Should I tell them?
I reviewed my medical records and there are two sets of progress notes by my cardiologist in my hospital records for two different days. In one, it appears he was requested to consult on my case by my surgeon. In the other, he discussed medication changes with me (which I vaguely remember, as I was still hazy post-op). In both, he noted that he reviewed radiology images and my medical records.
Prior to my surgery, he was the physician whom I consulted for cardiac clearance, as he was familiar with my cardiac history, so it makes sense that he would be the cardiologist whom my surgeon would contact.
So I will use this information to gain further clarity when I make my calls on Monday.
And for those who asked about/hoped I was doing well – thank you. I am. I have fully recovered from the surgery and although I am continuing ongoing treatment I am currently feeling good! 
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Good news on all fronts!
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