Why can it take so long to receive medical bills?

When you visit a doctor’s office, you may experience a delay in getting your bill. With the back-and-forth among health care providers and insurance companies, often times patients wait months to receive their bills.

But with all of our advanced technology and instant access to information, why does it take so long?

Multiple parties involved

A hospital or office verifies your coverage when you visit. After performing services, the hospital will submit a claim to your insurance company. Patients usually are responsible for a co-payment, deductible and coinsurance for the service(s) provided. Co-payments are expected at the time of service, deductibles and coinsurance are billed after the visit.

The actual amount of patient responsibility depends on if the doctor is in the insurance company’s network and the corresponding rules of the insurance company, which are based on the coverage benefits outlined in the individual policy or policies. The insurance company’s payment terms become complicated and differ greatly depending on the individual health care provider’s contract with them. This can result in claims processing delays and/or require the provider to re-process the claim.

The final bill, or collection of the deductible and coinsurance as determined by the insurance company, is what leaves many patients waiting weeks or months. And, when a patient receives multiple medical services during one visit, several bills could arrive over a lengthy period of time. A patient could receive a bill from a doctor, a hospital, a lab and even a second doctor who read the test results. Combine that with complications, such as delays, missing invoices or late billings by health care providers, and it can leave some patients waiting a long time to find out how much they owe.

Hospital Complications

Patient billing is much more complex at hospitals. When a patient visits a hospital  complex procedure involving several departments, departments may bill individually. That’s why patients sometimes receive one bill from the hospital, another from the anesthesiologist and another from the radiology department.

Billing procedures often vary by hospital. Some may send one bill immediately, while others may send numerous bills over several months.

In addition, a number of other factors can cause delays. These generally include: patients not providing accurate information about their health insurance coverage upon registration whereby the billing staff determines what coverage, if any, exists along with who should be billed primary, secondary etc., incorrect processing or coding (how insurers identify procedures or expenses) that may be rejected by an insurer and need to be re-processed etc.

Most hospitals try to insure  patients receive a bill as soon as possible. Despite these efforts, a “late” bill does not relieve the responsible party from having to pay for the medical services.

The bill that the provider sends can only reflect the amounts the insurance company determines as a patient responsibility. The Explanation of Benefits (EOB) from the insurance company may arrive before the actual physician/hospital bill does. You can make an accurate payment to the provider using information contained directly on the EOB as the amount will be equal to the bill.