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Retirement and Insurance

Appealing a Medical or Dental Claim

Richard Moseley (CLT) Chairman, Retirement & Insurance Committee Karen Browne MEC Benefits Specialist

D o you know what an EOB is and what you should do with it? EOB is short for Explanation of Benefits and you get one every time a claim is filed with a traditional insurance carrier like United Healthcare, Pru- dent Buyer, Blue Cross or MetLife Dental. If you have an HMO, you probably don’t ever see

them because the claims are usually paid in full once you pay your co-payment at the doctor’s office.

But for those of you who do receive them, here are some helpful hints on how to read one and what to do if you don’t think it is correct.

BLUE RIBBON INSURANCE COMPANY

I.D. #

888-88-8888

US Airways Inc.

PILOT NAME PILOT ADDRESS CITY, ST 88888

This is an explanation of the benefits for the bills received on 9/26/99.

Benefit Year:

1999

Amount Not

R M

Covered

K

TCN: 023-99271-6073082

Patient, PILOT

Service Bills Dates Submitted

Expenses

Pay

At

Amount Applied to

Deductible

Balance

Amount Payable

9/01

SMITH

9/01

Medical

$29.00

9/01

Physical Therapy

$14.00

9/01

Physical Therapy

$ 9.00

1

Totals

$10.00

$52.00

$10.00

100%

$19.00

100%

$14.00

100%

$ 9.00

$42.00

$42.00

$19.00 $14.00 $ 9.00

$0.00

$42.00

Actual Benefits Paid

Plan Information – 1999

Indiv. Deductible Family Deductible Individual Coinsur Lmt. Family Coinsur. Lmt. Lifetime Benefits

Plan $150 $400 $500 $1,000 Unlimited

$0.00

$150

$0.00

$400

$0.00

$500

$0.00

$1,000

$968.44 paid

Year to Date

Remainder

Remarks (RMK): 1 - This amount is your plan’s copayment, which is your responsibility

November/December 1999 – US AIRWAVES

41

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