Does a Policy Holder in Nevada Need to Pay a Bill if Their Health Insurance Doesn’t Pay a Claim and the Explanation of Benefits States No Payment is Required?

Question from laura, Does a Policy Holder in Nevada Need to Pay a Bill if Their Health Insurance Doesn’t Pay a Claim and the Explanation of Benefits States No Payment is Required?

Answer from AI:

In general, if your health insurance company in Nevada, or any other state, denies a claim to a provider they recommended and their Explanation of Benefits (EOB) states that you, the policyholder, are not responsible for the bill, then you typically should not have to pay. However, it’s important to understand the specifics of your situation and your insurance policy.

Understanding Explanation of Benefits (EOB)

An Explanation of Benefits is a document sent by an insurance company to their policyholders explaining what medical treatments and/or services were paid for on their behalf. The EOB will detail the services provided, the amount billed, the amount covered by insurance, and any balance the policyholder is responsible for. If the EOB states that the policyholder is not responsible for any payment, then typically, the policyholder should not have to pay.

Exceptions and Considerations

However, there are exceptions and considerations to keep in mind:

• Errors: Mistakes can happen. If you believe there’s an error in the EOB or the bill, contact your insurance company and the provider to clarify.
• Out-of-Network Providers: If the provider was out-of-network, you may still be responsible for some costs, even if the EOB initially states you do not owe anything. This is known as balance billing.
• Additional Services: If additional services were provided that were not covered by your insurance, you may be responsible for those costs.

What to Do If You’re Billed

If you receive a bill from the provider despite the EOB stating you owe nothing, do not ignore it. Contact your insurance company and the provider to understand why you’re being billed. If you’re unable to resolve the issue, you may need to seek legal advice.

Seeking Legal Advice

While this information provides a general understanding, health insurance claims can be complex. If you’re facing a situation where your insurance has denied a claim and you’re unsure of your responsibility, it may be beneficial to consult with a legal professional. They can provide personalized advice based on your specific situation and the details of your insurance policy.

Please note that this information is intended to provide a general understanding and is not legal advice. Always consult with a legal professional for advice related to your specific situation. For more information on health insurance claims and your rights as a policyholder, you can visit the Nevada Division of Insurance or the HealthCare.gov websites.