Eligibility, Payment, and Billing Procedures

Eligibility, Payment, and Billing Procedures - However,...

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Health care provider companies will have detailed insurance contracts that lay out the details of exactly what is and what is not covered. In general, simply by reading the fine print, a patient can figure out where he or she stands, in terms of patient benefit eligibility. If a certain procedure is not covered under the patient’s insurance, the service provider will advise that patient and let them know that they are responsible for paying any charges. The patient can either pay the amount in full at the time of service or the patient may be able to set up payment arrangements with the medical provider to make sure that the bill is paid. There are so many examples of how the steps factor into the eligibility of a patient charge as it is corresponding with billing transactions. One example of a patient charge is if 24 year Katherine Pierce came in wanting to have cryosurgery done but her insurance only covers procedures related to family planning.
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Unformatted text preview: However, that facility tried to bill the patient after the fact that the insurance does not cover the procedure so they send a detailed bill in the mail with the date of the visit, what procedure was done and what the patient owes the medical provider. From then on the member can either pay amount in full or set up a payment arrangement with facility. A second example of a patient charge is if 19 year old Bruce Smith went to get all four of his wisdom teeth pulled and his insurance only paid for 80% of that bill. The medical provider will either have the member pay for the service up front or send a dated bill in the mail describing the services performed and the cost member owes. The patient can either pay in full or work out a payment arrangement with the medical provider as well....
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