What You Need To KnowInsurance Billing and Payments
Insurance Billing and Payments
The process for billing insurance and receiving payment can take many months to complete for healthcare providers. When the insurance company receives the initial claim from a provider, the patient receives an Explanation of Benefits (EOB).
The most important item to acknowledge and understand is that an EOB is NOT a bill. This is a summary of the initial processing of the claim by the insurance company. In certain cases, not enough information has been provided to the insurance company for them to pay the claim, therefore payment is denied and 100% of the billed amount is listed as patient responsibility. When this occurs, the healthcare provider will correspond with the insurance company, provide the necessary information requested and the claim will be re-processed.
Occasionally, the insurance company will pay the claim, but accidentally send the payment (check) to the patient rather than the provider. If this occurs, DO NOT cash this check – contact the provider listed on the EOB enclosed with the check to make arrangements to send them the payment.
It is common for insurance companies to delay processing claims and issuing payments to providers. This puts undue stress on the providers and can push unnecessary financial responsibility onto the patient.
Fortunately, there are steps that can be taken to reduce the risk that the insurance company will push undue financial responsibility on you, the patient.