The Mystery of the Medical Bill: Why Do You Sometimes Get One After Already Paying at the Doctor’s Office?

The Mystery of the Medical Bill: Why Do You Sometimes Get One After Already Paying at the Doctor’s Office?

Have you ever had this happen to you: You go to the doctor, pay the copayment, go home and weeks later receive another bill. If so, you’re not alone. It’s common to receive a bill after you visit a doctor—even if you paid a copay at the time of treatment.

So, why does this happen?

After you leave your doctor’s office, someone there submits a claim to your insurance provider that lists the services you received. Your insurance provider uses that information to pay your doctor for those services. Next, you will receive something called an Explanation of Benefits (EOB) that shows all the services provided during the visit. The EOB is not a bill, but it can be confusing because it does show what your insurance company paid and what they didn’t cover. The EOB is just for your files, no response is needed. If there were services not covered by your insurance provider, you’ll receive a separate bill that shows what you owe.

There are a number of factors that determine whether or not you have to pay extra money, including the type of plan you have and whether you went to a provider who is in-network or outside of your plan’s network.

A few things to keep in mind: If you receive a statement before your insurance company pays your doctor, you do not need to pay the amounts listed at that time. Wait until after your insurance company pays to find out if you owe any remaining balance. It’s also important to look at your bill carefully and understand all the items on it to make sure you’re being charged the correct amount. If you think your doctor’s office billed your services incorrectly, call your physician’s office to verify they used the correct billing codes.

To avoid any surprising bills in the future, make sure you understand exactly what your health insurance covers before you head to the doctor. Additionally, going to health care providers within your network can help avoid any extra out-of-network fees. Blue Cross Blue Shield of Michigan members can check their coverage by calling 1-888-288-2738 or logging into the Blue Cross Blue Shield of Michigan member portal. You can also check which physicians are in-network and out-of-network here.

For more help understanding your coverage, check out these blogs from both this site as well as A Healthier Michigan:



Photo credit: Alan Levine

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