The Explanation of Benefits is not the same thing as your health care bill

Many times, I ask my clients for copies of the medical bills they incurred after an accident. Immediately after a car accident, some people go to the doctor, hospital, etc and start incurring medical bills. These are some of the bills I need to help properly represent my clients. Some doctors will provide this information directly to me, especially if they've handled personal injury matters in the past.

The answer I almost always get is, "Oh, I got that from my health insurance company. They sent me the bills in the mail." Well, my clients are usually wrong about this. What they actually got is an "Explanation of Benefits" form (also known as an EOB Statement). This form is from their insurance company. It generally shows what they were billed, any discounts applied to the bill, what the health care insurance actually paid (if anything), and any amount the client is expected to pay. It looks like a bill of some sort, but it's not a bill.  It's an "explanation" of benefits.

You see, the EOB statement is NOT your bill. The actual bill is a recitation of all the services etc. you received from a particular health care provider and how much they charged you for the services. It's similar to shopping at the store - they give you a receipt that shows all the things you bought and how much you were charged. That's what I need. What you get from the health care insurance company is a document generated internally by the health insurance company - not the actual bill from the health care provider.

Your co-pay and EOB information is important but it's not the actual bill. How do you get the actual bills?  You call the health care provider and say, "Hey, send me my bills." They will either mail/fax them to you or you can pick them up. You are entitled to that information. Make sure to forward all bills to your attorney.  Realize that many health care providers do not do their own billing.  Their billing is often handled by a third party company, often off the premises, and sometimes not even in California.  Either way, you are entitled to your own bills.

I also like to get copies of my clients' EOB statements as well to show clearly what was billed and what was paid. That information is also important, but please don't confuse your EOB statements for your actual health care billing. They are not the same thing.