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ASK's avatar

I was told by the office administrator that they cannot refuse to do the tests the doctor orders because of the form. Your insurance will normally send you an EOB Explanation of Benefits that will tell you what you owe, above what they have covered.

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Peter GL's avatar

what I find odd is when I look at the EOB Explanation how much overcharge is done vs how much insurance approves and how much I am required to pay!!!

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ASK's avatar

So there is actually a purpose in doing that. When you bill Medicare as a provider, you know they will only cover X for a payout of $Y. So you have to bill at a higher rate than $Y, because if you bill $Y, they will pay less. It’s a very screwed up system.

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