Unless one has insurance or medical billing experience, it may be difficult to understand why Health Insurance in Oklahoma City OK, covers some healthcare services and not others. Sometimes, doctors bill patients for services that are already covered. If a patient isn’t sure why they are receiving a bill, taking a few minutes to read the full info here may prove beneficial.

In vs. Out-of-Network Care

When patients use a doctor outside the insurance company’s network, balance billing is common. Here, the provider charges more than the company is willing to pay and sends the patient a bill for the balance. While the practice may be frustrating, it’s legal. It also proves the importance of ensuring a facility’s network status before requesting healthcare services.

Covered Service, or Medical Necessity?

Although Health Insurance in Oklahoma City OK, might state whether a service is covered, that does not always mean the service will be paid for. In most instances, the service must be covered and medically necessary. If the insurer determines that the treatment or medicine isn’t necessary, the claim will be denied, and the patient will be responsible for full payment. Patients should ask their doctors for proof of the necessity of treatment.

Exclusions

Patients should read the fine print in insurance documents, especially the parts concerning exclusions. These could include anything from injuries sustained during the commission of a crime to vaccinations not needed in a certain part of the world. In most cases, a doctor’s bill reflects exclusions to covered services.

Getting Help

Before a patient contests a medical bill, they should verify that the insurer has not paid it. If it’s not paid, the patient should ask for an EOB (explanation of benefits) for the services rendered. On an EOB, patients will find the billed amount, the date of service, the amount paid by insurance, and the remaining balance, if any. If any part of the claim is denied, a decline code will give the reason.

Once the patient understands why a bill has been partially paid, or not paid at all, it’s time to review the bill. If the doctor’s balance doesn’t match what’s on the EOB, the patient should call their doctor for clarification. Coding issues can cause claim denials, and doctors’ offices can often make corrections and resubmit claims.