Medical Bill FAQs
How much will I owe for my service?
The amount that you will owe for your service depends on many factors: Your plan's copayment or deductible amount and if you have met it, the provider's charges for your medical service, whether you are in-network or not, and more. In the simplest case, you may owe a flat $10 or $20 copay. In more complex cases, the amount you owe will depend on the provider's charges, the percentage that you will be responsible for, and if you've met your deductible or not.
Why aren't all of my medical charges on one bill?
When you seek care for a service, you are often treated by several different providers who come together as your care team. The hospital, your primary doctor, a surgeon, an anesthesiologist, and your pharmacist may all be part of different organizations who come together to provide you your care. As a result, each provider may send their claim to your insurance separately, and you may receive a bill from each after they are processed.
Be sure to keep track of the EOBs from your insurance as you receive them, and file them according to the medical event. Doing so can help you piece together all of the various services that were provided as part of one medical effort, and ensure they are processing correctly.
Who do I talk to if my healthcare claim hasn't paid?
If the claim for your insurance has not been paid, first review any documentation from your insurance. If there are no requests for additional information or claim denials, contact the member services department of your insurance. The medical billing office of your provider may also be able to assist if you feel there is an issue with your claim processing.
What does it mean if my insurance is requesting additional information or paperwork?
Your insurance may request information from your provider about the service or information from you about the service or your coverage. The reasons may vary. They may want to understand if you have other coverage, they may want to ensure the procedure matches what was authorized, or they simply may need to validate that the services you received are covered by your particular plan.
What should I do if I don't have the money to pay my bill?
Call your healthcare provider, from whom you received the bill, and discuss your situation. Many providers have procedures set up for patients who are unable to pay their bill.
Can my healthcare provider ask me for payment at the time of service?
Yes. The amount that you will ultimately be responsible for can be requested of you at the time of service. The exception would be an emergency room visit where you must be seen regardless of your ability to pay.
Paying at the time of service should reduce (or resolve) any amount you are billed for once the claim has been processed.
Why did I get a bill from a physician who I didn't see?
In cases where you were treated by a highly qualified physician assistant or nurse practicioner, his or her care for you was overseen by a physician who you may or may not have met. Regulations require that the claim be filed with this supervising physician listed as the provider.
Can I get a copy of my medical record?
Yes, but medical offices treat your records with the utmost respect and privacy. If you would like a copy of your medical record, most offices require written consent and perhaps getting the records in person so there is no risk of a third-party handling them.
What is a reasonable and customary charge?
Many insurers simply pay a "reasonable and customary" charge to a provider, which is usually a typical or average price for that service in your region. In cases where you see on your EOB that some of the charges were above reasonable and customary and were not covered, you may be liable for the balance. It probably means that you were receiving the services out-of-network.