I thought I would start the blog by explaining the billing process between doctors, health insurance carriers, and you. I know it can be confusing at times due to the countless medical statements sent from multiple sources. I’m hoping I can help provide some clarity on medical insurance bills. If you have any questions, please feel free to contact me via email. I will be glad to help.
Each time you visit the doctor, did you notice the volume of bills you’ve received afterwards? Are all these documents beneficial? I’m sure many people simply discard any documents that do not appear to be bills. However, often times you cannot necessarily tell a bill from a summary of the visit. There is a way to identify the meaningful documents.
The doctor will send a bill for the visit after rendered to the insurance company first for processing. The portion sent to you directly from the doctor is typically your patient responsibility, based on co-pay, deductible, and co-insurance. However, the insurance company will send an Eligibility of Benefits summary around the same time. It is important to verify that the patient responsibility listed on the insurance company’s Eligibility of Benefits summary matches the amount on the doctor’s bill. If your responsibility is not consistent, you may need to call one or both parties to resolve the discrepancy. It is important to wait for both documents before settling accounts.
The reason to verify the doctor’s bill against the insurance carriers information is to ensure the claim truly processed correctly. If the insurance company did not pay their portion of the doctor’s bill there will be a reason listed on the Eligibility of Benefits summary. The denial information will provide additional details, but ultimately you can appeal. The claims processing system is not flawless from either the doctor or the insurance carrier. For this reason, it is good to keep the Eligibility of Benefits summaries.
If you have a test, procedure, or other service performed during the doctor’s visit, you could receive a supplemental bill. In addition, the Eligibility of Benefits from the insurance carrier should also reflect. However, the bill might not come directly from your doctor. For example, if blood was drawn during the visit, the test will be sent to a lab. The lab will bill for these services, using the same process as the physician. In this scenario, you would receive at least 4 documents post visit. If you have blood drawn and a biopsy, there could be even more documents. It is difficult to keep track after a certain point, especially if you have undergone treatment for an extended amount of time. The important point is to keep checking the Eligibility of Benefits summaries to verify how the claims were processed. This is the quickest way to find out how and why you are being charged for services. It is also a good way to keep account of the financial implications, dare I say burden, coming from the doctor.
This is the beginning discussion on billing, but I’ll start in the coming weeks to dive deeper into this topic. Hopefully, I can answer your questions and provide useful knowledge that is not available from other sources today. I’ll try to incorporate everyone’s questions into the blog as well. Until next time.