You’ve been admitted to the hospital, have undergone a surgical procedure and, finally, you are home recovering. You think that the pain is all behind you. Then…your medical bill arrives.
This convoluted and confusing glut of information is enough to make anyone’s head spin, and, while each situation varies, considering the type of procedure you had done, as well as your insurance coverage(s), there are some common items that can be found on most medical bills.
The first step in understanding medical bills is to determine whether you are actually looking at a medical bill, sent to you by your medical provider, or an Explanation of Benefits, or EOB, sent to you by your insurance company.
An EOB is essentially an acknowledgment being provided to you by your insurance company that your health care provider has submitted a claim to them and they have processed the claim. This form will provide an indication of the total amount being claimed in dollars, as well as the services that doctor has indicated that he or she has provided. An EOB will indicate the amount the insurance company is paying to the health care provider, as well as the amount that you, as the patient, will be responsible.
The amount for which you are responsible can consist of your deductible (the total annual amount that you are required to pay before your health insurance company will pay anything towards your medical expenses), a co-pay (a specified fee for certain services that a member is responsible to pay, often at the time of service), a coinsurance (the percentage of medical expenses that you are required to pay towards your medical expenses after the deductible is met), or a combination of these items.
One last entry that you will see on both the EOB as well as the medical bill itself is the adjustment. Insurance companies and providers agree on a set rate for each and every procedure conducted by health care providers, and the adjustment reflects the decrease by the insurance company to get to the actual billable fee to that amount. However, keep in mind, this EOB is not a bill. However, understanding the EOB is a good part of the process of understanding medical bills.
Typically, your health care provider will send a bill to you at one of two points following the treatments or services you were provided, and understanding medical bills necessitates that you be clear of the distinction. If the provider had incorrect or incomplete health insurance information on file, you may receive a large bill that lists all of the services and/or procedures completed, their dates of completion and an itemized charge for each. The total balance of these services will be listed as outstanding and the expectation is that you as the patient will be making the payment. Now, if you have health insurance that was valid at the time that you received this care, you can typically provide this information to the provider who will then file a claim with the insurance company, which will usually result in a much more manageable bill being provided to you in follow-up.
If your health care provider has the proper insurance information on file for you up front, this “follow-up” bill may actually be the first and only one that you receive. This bill will already take into account the amount that your insurance company will be paying, factoring in, of course, your deductibles, any necessary adjustments and any co-pays that you are going to be responsible for. It will also provide you will a bottom line figure which represents the total that you will need to pay directly to the health care provider for the services rendered.
Unfortunately even when you understand the basics, medical bills can be frustrating and complicated. Let Kare360 handle the hassle while you focus on getting better. That is, after all, what it’s all about!