As Michigan’s premier employee benefits agency, we assist our clients with any claim or billing issues they may have with a carrier. One of the most frequently asked questions revolves around paying medical bills and how they were processed through insurance. From a standard office visit with your doctor to a procedure at the hospital, most medical treatments have a price, even if you have insurance.
Understanding how medical bills are paid is important and can help you manage out-of-pocket expenses.
When you check in at the doctor’s office, they will first ask you to present your insurance card. Using the information on your card, the doctor’s office can see what is and is not covered by your health plan. They can also obtain the correct contact information to submit a claim (or bill). Every time you receive health care there is a cost associated, and a claim is created. So what happens to this said claim after you’ve received treatment?
- Your doctor or the provider creates a claim for your visit. Each expense is itemized and coded in a way that allows your insurance company to understand what was done and why it was done.
- A claims agent at your insurance company reviews the claim. They update the pricing on the claim with the company’s negotiated rates. They note what portion of the fees the insurance company can pay, based on your policy and how each expense was itemized. The claim is then sent back to the provider.
- Your provider updates their system with the feedback received from the insurance company, and sends you the revised bill. You are responsible for any outstanding charges not covered by insurance. It’s important that you review both your EOB (Explanation of Benefits) and bill closely to make sure the claim was processed correctly. If you have questions, don’t wait! Call your doctor, BCBSM, or as an AFG client, your dedicated account manager with your questions or concerns.
- Medical bills can sometimes be unexpected expenses. If you cannot pay your entire bill at once, call your doctor or the hospital where you received service to coordinate a payment plan. Many providers are willing to arrange for you to pay smaller, more feasible monthly payments for a set amount of time. Don’t wait or leave bills outstanding, it can wreak havoc on your credit if medical bills get sent to collections.
One more tip: Save your EOBs and bills. That way, if you have a question, you have all the documentation necessary to either call upon the help of your dedicated AFG account manager or call your insurance company for explanation. Also, companies like BCBSM have online member portals where you can view and download your entire Explanation of Benefits for any services.
What other health insurance questions do you have?
*Source: BCBSM
