You've gone to the doctor, you've had your checkup or procedure, you get your bill and then one of two things happens. Either you take that bill home and mail it off to your insurance carrier or your doctor takes care of doing that for you. Some time then passes and you want to know just one thing. Where is your check? Does anybody even know you exist? Hopefully, this installment will give you an understanding of what goes on in the medical billing process which can sometimes make it seem like it takes forever to get your claim paid.
First of all, most people don't understand why sometimes you have to send the claim to the insurance company yourself and other times the doctor will do it for you. Plus, in some cases, the doctor will allow you not to have to pay up front and in other cases you have to pay for services first and get reimbursed by the insurance company afterwards. This is all dependent on your insurance company. It has nothing to do with your doctor. The kind of insurance you have will determine whether or not you have to pay up front and whether or not you have to send in the claim on your own. So when you get insurance, make sure you read the terms. If you're not sure of something, ask.
Okay, so now that you've either sent the claim in yourself or had your doctor send it in, just where is your check? Well, this depends on a number of things. First of all and this is the most important, if you didn't pay for services up front, you're not going to get a check. The payment will be sent directly to your doctor. So you will have to find out from your doctor if your claim was paid. Yes, it's a pain in the backside but that's just the way it is. In most cases, if the claim was denied, you won't be notified of this by the insurance company. What will happen is that you will get a notice from your doctor that is an EOMB, or explanation of medical benefits. This will have a list of all services performed and what was paid and not paid. At the bottom, will be the outstanding balance, which you will have to send to your doctor. If you have been given a procedure that required anesthesia, you'll get a bill from the anesthesiologist as well and you'll have to pay that as well, along with any bills sent to you from the surgeon. Yes, this can get very involved.
If, however, you did pay for all services up front, then any money you have coming to you will be mailed to you from the insurance carrier. Depending on who it is, you may get one check for each service separately, or you may get just one check for all services combined. Check with your insurance carrier for how this works.
So, if you're wondering where your check is, hopefully the above explanations will give you some idea. The medical billing procedure can be quite confusing. This article has hopefully made it just a little clearer.
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