Navigating the world of medical billing can be overwhelming, especially if you’re unfamiliar with how the process works. At City Care Family Practice, we want to ensure that our patients have a clear understanding of how medical claims are processed and what to expect when it comes to insurance coverage and patient responsibility. In this article, we’ll walk you through the basics of medical billing, what happens when your doctor’s office sends claims to your insurance, and why you might receive a bill for services you thought were covered.
How Medical Billing Works
When you visit a healthcare provider like City Care Family Practice, the process doesn’t end when you leave the office. Behind the scenes, a detailed billing process takes place to ensure the services you received are properly covered. Here’s a basic overview:
- Check-In and Insurance Verification – During your visit, we collect your insurance information and verify your coverage to determine what services your insurance will likely cover.
- Coding and Documentation – Medical providers document the services provided and assign specific codes (CPT, ICD-10) that describe the procedures and diagnoses. These codes are critical for accurate billing.
- Claim Submission – The medical practice submits a claim to your insurance company, detailing the services provided and the associated costs.
- Insurance Review – Your insurance company reviews the claim and determines how much they will cover based on your plan’s benefits, deductibles, copays, and coinsurance.
- Explanation of Benefits (EOB) – After processing the claim, your insurance company sends you an EOB, which outlines what they paid, what they didn’t cover, and the amount you may owe.
- Patient Billing – If your insurance company does not cover the full cost, you may receive a bill for the remaining balance, which is your patient responsibility.
Why You Might Receive a Bill
Even if you have health insurance, it’s possible to receive a bill for medical services. Here are a few common reasons:
- Deductibles and Copays – You may owe a portion of the cost if you haven’t met your annual deductible or if your insurance plan includes copays or coinsurance.
- Out-of-Network Charges – If your provider is not in your insurance network, you may be responsible for a larger portion of the bill.
- Non-Covered Services – Some services, like certain tests, procedures, or preventive care, may not be covered by your plan.
- Claim Denials – Your insurance may deny a claim due to incorrect coding, lack of prior authorization, or other administrative issues.
Comprehensive Q&A
Q: What should I do if I receive a bill I wasn’t expecting?
A: Contact our billing department for clarification. We can review the charges and help you understand why you received the bill.
Q: How can I avoid unexpected medical bills?
A: Make sure to verify your insurance benefits before your appointment, including understanding your deductible, copays, and out-of-network coverage.
Q: Why do I sometimes get multiple bills for one visit?
A: You may receive separate bills for services like lab work, radiology, or specialty consultations that are billed separately from your office visit.
Q: What is an EOB, and why is it important?
A: An EOB (Explanation of Benefits) is a statement from your insurance company detailing what they paid and what you may still owe. It’s important to review this carefully to ensure accuracy.
Q: How can I appeal a denied claim?
A: If your claim is denied, you have the right to appeal. Contact your insurance provider for instructions on how to initiate the process.
Contact City Care Family Practice
For any billing questions or concerns, please reach out to our team:
City Care Family Practice
461 Park Ave South, Fl 9
New York, NY 10016 (at 31st Street)
Phone: (212) 545-1888
We’re here to help you navigate the complexities of medical billing and ensure you receive the care you need without unnecessary financial stress.