EOB Problems

by 
May 25th, 2016

Have you had to send money back to a dental insurance company? You may have received a letter informing you that a patient received benefits but then turned out to be ineligible and now the insurance company wants their money back. Hopefully, you sent them a check for the amount they expected to receive and then you're on your own to collect from the patient.

However, sometimes the insurance company does not send you a refund request letter. Sometimes they send you a remittance letter simply stating that again, a patient received benefits they should not have and now the insurance wants its money back. However, in this letter they inform you that they will be taking this money from your next EOB. So, you are keeping an eye out to see how that will happen and which patients will be affected.

Dental Insurance taking its refund from another patient

Soon, you may receive the next EOB and start your own 'Where's Wally?' game. Starting with the first patient, you see the normal column showing submitted fee, adjustment required, copay, insurance payment and patient portion. Everything looks normal. So, did the insurance actually pay on this claim? It sure looks like it. But wait, here's the clue: in the top right corner of your EOB beside the line for "Check number" its blank. That"s how the insurance company is telling you that no, they didn't actually pay for any of the patients listed on that EOB. Even though the columns for each patient say "Insurance paid"' they didn't!

So, you've figured out that EOB, how about the next one? You start by looking at the "Check number" line and you see EFT. So, they must have paid on this one, right? Wrong. There are several patients listed on this EOB, and you could tell from the summary on the first EOB that there is still money owed, but there is no way to tell which patient they took the money from. Ok, its time to wave the white flag and call the dental insurance company. After your standard wait time, a very nice representative explains that, in fact, they didn't take it from any one patient, they just subtracted it from the total. And, she reminds you that you have to give credit to the patients even though you didn't actually receive the money.

So, what can you do? There are two options for practices who have to send money back to the dental insurance company: refund or remittance. Ask to be set up in their system for the refund option, this means that when this happens again, your office will receive a letter asking you to refund the money. The other option is what you are stuck dealing with now: the insurance takes money out of their next remittance (insurance payment

References:

EOB Problems. (2016, May 25). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/eob-problems-28551.html

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