Miscellaneous Benefit Descriptions

Explanation of Benefits (EOB)

Improvements have been made to the Explanation of Benefits (EOB) from Midwest Group Benefits. This statement, which shows how medical claims are paid, now contains an Employee ID number (not social security number). It contains a column showing the balance the employee must pay for an office visit. The Plan Year Benefit Summary shows how much deductible and out-of-pocket has been met for the year. Use the Midwest Group Benefits website to view claims, benefits plan and email questions.

Hospital and Outpatient Price Comparison Links

There are two websites that employees may access in order to view price comparisons of medical charges. View outpatient and inpatient charges for Wisconsin hospitals and clinics. See Iowa hospital inpatient information. Both of these sites have additional information and explanations such as the difference between hospital bills and physician bills, what an explanation of benefits is, etc.

Self-Audit Billing Credit

The Plan offers an incentive credit to all employees to encourage examinations and self-auditing of eligible medical bills to ensure the amount billed by any provider of service accurately reflects the services and supplies received by the employee or a covered dependent. The employee is voluntarily asked to review all hospital and doctor bills and verify that he/she has received each itemized service and the bill does not misrepresent either (regardless of the reason).

In the event an employees self-audit results in elimination or reduction of charges, 25 percent of the amount so eliminated or reduced will be paid directly to the employee (subject to a $10.00 minimum savings), provided the savings are accurately documented, satisfactory evidence (a copy of the incorrect bill and a copy of the corrected billing) of a reduction in charges is submitted to the Claims Supervisor. Credit payment is limited to $500 per calendar year.

This self-audit is in addition to the payment of all other applicable plan benefits for legitimate medical expenses. Participation in the self-auditing procedure is strictly voluntary; however, it is to the advantage of the plan as well as the employee, to avoid unnecessary payment of health care dollars and any subsequent remaining balance (the employees liability) on an incorrect billing.

This credit will not be payable for charges in excess of the reasonable and customary fee, regardless of whether the charge is or is not reduced.