Your PPO Can Save You a Lot - If You Use It Properly
Use of PPO Networks Reduces Medical Bills
Jacki called. “Why aren’t my medical bills reduced?”
She asked why she was getting a big bill from the doctor, and asked “I thought having a health plan would reduce my medical bills!”
The Short Answer to Reducing Medical Bills
It’s a common question, especially from people who do not go to the doctor very often. Therefore, you should know “How does a PPO network work with your health plan,” and how much does it save you? It’s simple really.
Go to a doctor in your PPO network – get a discount and reduced medical bill.
Go to a doctor not in your PPO – pay retail. Your choice.
Here’s a basic guide for the times you go to a PCHS doctor.
- Your health plan is from X-company, and you can see it includes the PHCS network.
- The PHCS doctor verifies you. After that, you will have discounted services.
- Your doctor sends claims to the PHCS network.
- Now, you can review the bills and you should look for the charges and the discounts by the doctor.
- Your health plan company sends you an EXPLANATION OF BENEFITS (EOB) statement, therefore you can learn:
- the normal cost of the services you received
- the discount by the PPO
- the amount the health plan company paid to the doctor, if any
- the amount you owe
- EOB is the acronym for this statement. Some companies call it EOS.
- To summarize, compare the doctor’s bill with the EOB. As a result, you can be assured you are being correctly billed.
A Tip on Tracking Doctor Bills thus Reducing Medical Bills
You should hold on to medical bills and stack them together for each treatment. Then, look for the EOB, that statement is the key and has all the basis for all other bills. Verify the costs on the bills. For example, what services were charged and how much of a discount is listed. Also, how much was paid to the doctor. Finally how much do you owe? That part is usually shown on the EOB as “patient responsibility.”
Missing an EOB?
If you don’t get an EOB then it’s because the doctor’s office either has not submitted the claim OR your CLAIMS DEPT told them to correct it and re-submit it. Happens a lot!
You see, by law, the health plan company must complete a claim in 30 days. Sometimes claim have errors and processing time can be longer.
Review these medical documents and look for missing information. Search for errors and contact the provider or the health plan’s customer service if necessary.
Closing Points for Reduced Medical Bills
- A PPO network is not an insurance company. It is a separate organization.
- The discount applies even if you have not reached your deductible
- the discount is an obligation on providers and you get a discount.
There are probably other things that may cause you to have questions about insurance bills. It can sometimes seem complicated.
We are here to empower you to fully use your health plan and to make you aware of the benefits available. Most people use their plans infrequently. Doctor’s invoices and hospital’s lengthy bills are confusing enough. Next, the EOB’s start coming in. All that can seem overwhelming. HelpInsureUs tries to teach you the navigation techniques. Feel free to call or email with your questions. HelpInsureUs can make it easier for you if you let us.