Medical Billing

# Patient Education: Understanding Their Medical Bills

- July 2, 2024
- Posted by Brian Bertrand

02 Jul

Medical bills can be difficult to understand if one is not aware of certain medical terms and codes used by medical professionals. They have a specific pattern that needs to be learned. These bills give information about the patient’s disease and the cost of the services he enjoyed from healthcare providers.

This article aims to guide you in how to check medical bills properly. We will also discuss the important parts and processes of medical billing to better understand patients.

## The Basics of Medical Billing – How to Check Medical Bills

### What is a medical bill?

In the United States, a medical bill is a declaration that shows data on the facilities patients receive from healthcare providers and the cost of those treatments. Healthcare organizations gather patient data, including visits to the doctor, tests, hospital stays, surgeries, and the total cost of the procedure. This bill is sent to the patients and a third party, which can be an insurance company.

### Key Components of a Medical Billing

There are some parts of the medical bill that help how to read a medical bill accurately. These components are listed below:

#### Patient Information:

This part deals with the patient’s personal details such as name, home address, personal phone number, phone number of at least two close relatives, and ID card number.

#### Provider Information:

This part deals with the personal details of the healthcare provider, such as his name, home address, ID card number, and phone number.

#### Date Of Service:

This part includes the starting and ending dates of the medical services.

#### Description Of Services:

In this part, all details of the medical treatment are enlisted in the medical codes (CPT or ICD) that explain all processes of the treatment.

#### Charges:

This part includes the cost of the services provided.

#### Insurance Information:

In this section, details about the insurance company of the patient are provided.

#### Patient Balance:

The amount which has to be paid by the patient is enlisted in this section.

## Common Medical Billing Terms

Read this guide to understand all the basics related to medical billing:

- Deductible: The minimum amount that a patient has to pay before insurance coverage starts.
- Co-payment: The cost that the patient pays at the time when he receives medical services.
- Co-insurance: When the deductible is met, then the patient has to pay a certain amount for the received services.
- Explanation of Benefits (EOB): It is issued by the insurance company that describes the total cost of a patient’s treatment, which has been paid and which has to be paid.
- Premium: Premium is a cost that policyholders pay to the insurance company every month.
- Network: A network is a team of healthcare providers and services.

## The Medical Billing Process

### Step-By-Step Billing Process

There are some steps of the billing process whose understanding is important for the patients:

- The patient visits a physicist and gains medical services.
- After receiving treatment, the medical practitioners assign codes for the specific services provided by them with the use of a standard coding system (CPT, ICD-10).
- Then comes the process of claim submission, in which a physician submits the bill for the services and facilities presented to the patient to the insurance company.
- The next step is insurance processing, in which the insurance company, after receiving the bill from the healthcare department, verifies the whole procedure and issues the amount of the treatment.
- After the verification from the insurance company, the final decision is made on the reimbursement clearance or claim denial.

### Understanding Medical Codes

There are some medical codes that are used to describe the medical services that are offered to patients. A better understanding of these codes helps in how to check medical bills.

- CPT (Current Procedural Terminology): These codes are used to describe the medical, surgical and diagnostic processes.
- ICD (International Classification of Diseases): These codes describe diseases and their symptoms.

### Common Issues With Bills

#### Errors in medical bills

There are chances of errors in the medical bills that affect the amount of medical coverage. For example:

- Duplicate Charges: Sometimes, the bill shows the same service twice.
- Incorrect Codes: The use of wrong codes charges double the actual price.
- Services not provided: Services that are not offered to the patient are mentioned.
- Insurance errors: There are some errors regarding the insurance policy or insurance coverage.

#### How to identify and dispute errors

- Review your bill and EOB: Compare your EOB and medical bill carefully.
- Check for common errors: There can be errors such as any service mentioned twice, wrong codes for the service, and the facilities you have not received.
- Contact your provider: If you notice any uncertainty in the bill, then contact the healthcare provider’s billing section to clear the query.
- File an appeal: If the insurance company and healthcare facility don’t pay attention to your matter, then you can file an appeal.

## Navigating Health Insurance

Proper knowledge about health insurance is necessary for managing medical bills. There are some types of health insurance plans:

### HMO (Health Maintenance Organization)

HMO is a type of insurance policy in which policyholders are bound to only consult the specific physicians who are actually in the HMO plan.

### PPO (Preferred Provider Organization)

This type of healthcare plan allows policyholders to seek care from healthcare providers outside the network. But, this demands a higher percentage of the amount.

### EPO (Exclusive Provider Organization)

It is a managed healthcare plan in which extensive in-network physicians are included. There is no need for referrals. This demands low cost as compared to PPO.

### HDHP (High Deductible Health Plan)

This type of plan includes higher deductibles. The monthly premium usually remains low, and it allows policyholders to confer to the health savings account (HSA).

## Financial Assistance

### Financial Assistance Programs

Some medical practitioners help their patients through financial assistance programs so that they can manage their bills easily. Some are mentioned below:

- Special discounts are given to patients who are financially unstable. This process is called charity care.
- An installment system is presented for the payment of bills.
- Adjustments in the bill based on the patient’s financial condition, which is known as sliding scale fees.

### Government Programs

There exist some plans which are being initiated by the government for the ease of the patients. General education of these plans is essential for the patients. These programs are:

- Medicaid is one of the programs that offers medical services for patients who belong to the lower class of society.
- Medicare is another plan that presents offers to the aged people (65 and above) and to the young people who are facing any disability.

## Legal Protection

Patients should be properly acknowledged that there are laws that are built for their protection and support related to the medical billing procedure. For example:

### Affordable Care Act (ACT)

This law is built for people who are not in a state to pay their bills. People who belong to the low income can enjoy this act. They can attain proper health care coverage with the full attention of the physicians.

### No Surprise Act

This law helps patients when out-of-network bills are assigned to them. There are some protocols which need to be fulfilled before providing care from out-of-network physicians.

## Conclusion

It is important for patients to have a better understanding of how to read a medical bill without any mistakes. Understanding the medical codes and terms clears all billing confusion. It also eases the payment of your bills. If you have an idea of the medical billing process, then you can attain different medical offers and policies.

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