The Importance of Opening Your Mail after a Hospital Visit

by Latasha Gethers Hines | September 2019
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After receiving treatment at a hospital, it is important to review statements from the hospital and your healthcare plan to be sure any payments you have made or payments you are expected to make are correct. Paying attention to these statements may help you timely resolve any billing issues. It is important to open your mail after a hospital visit. Look out for the following:

Explanation of Benefits

Your healthcare plan provides an Explanation of Benefits (“EOB”), also known as an Explanation of Payment. The EOB typically lists the services provided, the provider’s full charges, the amount the plan allows the provider to charge based on its agreement with the provider, co-payments or co-insurance, the amount the healthcare plan paid, and the amount the patient is responsible for paying.

Provider’s Bill

The hospital or physician typically provides a bill reflecting the general services provided, the amount due from the patient, and any applicable credits for prior payments.

If you want more information about the medical care and services provided to you and the related charges, you can request an itemized bill from the hospital or physician detailing the nature of the charges or expenses incurred by the patient. Florida law requires hospitals and physicians to provide an itemized bill to patients. The requirements for hospitals are found in Florida Statutes § 395.301 and for physicians in Florida Statutes § 458.323.

Once requested, the hospitals must provide the itemized bill within seven days after the patient’s discharge or after the request is made based on whichever date is later. Florida law requires the hospital’s itemized bill to include, among other things, the following information that will help you asses the services you received:

(1) By date, the specific service provided;
(2) By date, the specific expense incurred;
(3) The provider of the services;
(4) The status of payment, such as paid, pending payment by a third party, or pending payment by patient;
(5) The amount due;
(6) The date by which the patient payment is due, if applicable;
(7) Notice of hospital-based physicians and other healthcare providers who provide separate bills; and
(8) The specific name of the drugs provided.

The itemized bill must include a telephone number of the hospital’s patient representative who can help expedite billing disputes.

Upon request, physicians must provide the itemized bill based on its regular billing cycle following the fifth day after the services are provided. Florida law requires the itemized statement to include the specific services provided and the charges for each service.

Reviewing the healthcare plan’s EOP and the statements from the hospitals and physicians will help you evaluate whether there are any billing errors and your responsibility for the services you were provided.

What to Do if You Have Questions about Your EOP or Billing Statement?

  • Call your healthcare plan, the hospital, or physician.
  • Review your healthcare insurance documents.
  • File an appeal, if necessary.
  • Kozyak Tropin & Throckmorton

    Latasha Gethers Hines
    Latasha focuses ber practice on complex commercial litigation, healthcare and real estate disputes. She earned a Bachelor of Science degree in Journalism from the University of Florida where she is a member of the Student Hall of Fame. She earned her Juris Doctor degree, cum laude, from the University of Miami School of Law in 1997.
    lgh@kttlaw.com

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