Another possibility is that your insurance claim was processed incorrectly. Another possibility is that your insurer has not yet handled your claim.
It’s also conceivable that your insurance policy does not provide coverage for the cost of the procedure. To understand the costs, it is essential to study your insurance coverage and speak with your insurer or the healthcare provider.
Even if you have health insurance, you can still get a bill from a hospital or clinic. You may have gotten a bill from a medical establishment for a variety of reasons. Here are some potential options.
You visited a healthcare provider or institution that was not in your network. It usually costs more to receive care from facilities or doctors who are not part of your plan’s provider network than it does to remain in-network.
Your insurance plan can ask you to pay the price difference between what you would have paid at an in-network provider and what you paid at an out-of-network provider.
Your copayment is still owed
Your copayment is a set sum that you must pay each time you use a covered medical treatment. Normally, you pay your copayment at the time of service, but in some circumstances—like if you need emergency care—you can be billed for it later.
Your deductible has not been reached
Your deductible is the sum of money you agree to fork over before your health insurance plan starts to pay for eligible medical treatments.
If your deductible is $1,000, for instance, your plan won’t begin to pay until you have spent $1,000 on covered treatments.
Some insurance plans cover specific healthcare services, such as routine checkups and screenings before your deductible has been reached.
You’ll be charged coinsurance
You consent to pay a portion of the expenses of a covered health care service, expressed as a percentage (for instance, 20%) of the permitted amount for the service, if your health plan includes coinsurance. Once your deductible has been satisfied, you must pay coinsurance.
The insurance company withheld payment or only paid a portion of the bill, for instance, if your health plan’s authorized amount for an office visit is $100 and you’ve met your deductible, your 20% coinsurance payment would be $20.
Insurance companies can think a procedure or test was unneeded or they might have established payments for operations and tests that are less than the facility’s fees.
In most cases, the patient is required to cover the difference. Be aware that you might be able to challenge such a ruling.
The healthcare facility erred Billing errors do occur
It is crucial to thoroughly analyze your invoices to confirm that you were only charged for the services you really received and that no services were provided more than once.
Contact your insurance provider at the customer service number shown on your medical ID card if you still don’t understand why you received a charge, or call the facility and ask to talk with someone in the billing department.
Normally, you are not required to pay a medical bill until your insurance company has paid the provider and processed the claims. The provider then sends you a charge for any additional expenses not covered by insurance.
An “EOB” is an explanation of benefits, which you could get from your insurance provider after getting services but before being given a bill. When you get an EOB, it means your insurance provider is processing a claim; you don’t need to do anything about it.
Call your insurance provider and the medical provider if you have questions about your bill or are unclear about whether your insurance claims have been handled and paid to the medical provider.
On the back of your insurance card, you’ll find the phone number of your health insurance provider. You can phone the provider and use the billing number listed on the provider’s bill.
Here’s what to do if you were given a bill after insurance:
*Check the document for the words “insurance pending” or any other sign that the hospital or doctor has sent the bill to the insurance company if you get something in the mail that seems to be a hospital bill (or a bill from a doctor). If it doesn’t, go to step 2 instead.
*Call the hospital or doctor and ask them to submit a claim to your insurance provider. You might provide them with the details from your insurance card or certificate. Proceed to step 3 if the hospital is unable to submit this bill or if they refuse to do so.
*Complete the Member Reimbursement Form for Blue Care Network. In accordance with the instructions on the form, fax or mail it. An “itemized statement” is requested on the form.
This is either the invoice you got or the statement the hospital or doctor’s office sent you if you paid the invoice in full.
The insurance company or the healthcare provider will then pay you for the services covered by your claim if you have previously paid for your treatment.
If you haven’t paid for your care, the insurance provider will pay the hospital or doctor on your behalf. Make a duplicate of everything you send to the insurance provider in case you need to check on the progress of your claim later.
Please go to the Prescription Drugs section for claims about prescription medications.