If a patient notices an unfamiliar item on their explanation of benefits, what should they do?

When a patient notices an unfamiliar item on their explanation of benefits (EOB), the most appropriate action is to contact the insurer and provider to seek clarification and correct any discrepancies. The EOB is a document that outlines healthcare services provided, the amount billed, payments made, and any patient responsibility. If there is something on the EOB that the patient does not recognize, it could indicate a billing error, a service they did not receive, or potential fraud.

Reaching out to both the insurer and the healthcare provider allows the patient to gather information regarding the charge listed. The insurer can clarify why a particular charge appears and whether it is covered under their plan, while the provider can explain what services were rendered and resolve any misunderstandings. Timely communication is essential to ensure that any erroneous charges can be rectified quickly.

Options that involve ignoring the issue or waiting for further communication do not address the potential for serious problems that could arise from misunderstandings or inaccuracies in billing. Reporting the issue to the police might be appropriate if fraudulent activity is suspected, but it’s not the first step a patient should take upon noticing a discrepancy on an EOB. Lastly, contacting human resources is typically not relevant unless the patient is an employee seeking clarification on benefits related to