Visit a doctor’s office or a hospital these days, and you’ll most likely experience that it could take quite a while to find out how much you actually owe. With all the back-and-forth among health care providers and insurance companies (especially involving secondary and in some cases third coverage), it’s not uncommon for patients to wait many months to receive all of their medical bills.
But with all of our advanced technology and instant access to information, why does it take so long?
Multiple parties involved
When you visit a doctor’s office or hospital, they typically verify your insurance information to find out what’s covered and what’s not. After performing services, the office or hospital will submit a claim to your insurance company (or companies if you have more than one policy). Patients usually are responsible for a copayment, deductible and coinsurance for the service(s) provided. While co-payments are usually expected to be at the time of service, deductibles and coinsurance often are billed after the visit.
The actual amount of patient responsibility usually depends on whether 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. Thus, the insurance company’s payment terms can become complicated and differ greatly depending on the individual health care provider’s contract with them, which can result in claims processing delays and/or require the provider to re-process the claim(s).
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 multiple medical services are delivered during one visit, several bills could arrive over a lengthy period of time. In this regard, 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.
Patient billing is much more complex at hospitals. When a patient visits a hospital for a more complex procedure and/or multiple procedures it can involve several departments or providers, many of which bill individually. That’s why patients may sometimes receive one bill from the hospital, another from the anesthesiologist and yet another from the radiology department.
And to make things even more complicated, billing procedures often vary by hospital – some may send one bill immediately, while others may send numerous bills over the course of 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 has to determine 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.
Such delays are unfortunate and most hospitals do their best to insure that patients do receive a bill as soon as possible after the medical services are rendered. Despite these efforts and the possible inconvenience, a “late” bill does not relieve the responsible party from having to pay for the medical services received from the provider.
The good news is, the bill that is ultimately sent by the provider regardless of the timing can only reflect the amounts determined by the insurance company to be a patient responsibility. Therefore, upon receipt of the Explanation of Benefits (EOB) from the insurance company, which may arrive before the actual physician/hospital bill does, an accurate payment can be made to the provider using information contained directly on the EOB as the amount will be equal to the bill regardless of when it finally does arrive.