The Insurance Paying Process
A health insurance plan covers certain healthcare services and treatments, and it details how much it’ll pay for each service and how much you’ll be responsible for. If you have a managed care plan, which most Americans do, your plan will also tell you which healthcare providers and facilities are in your network.
Before visiting a healthcare provider, ask what insurance will and won’t cover, and how much they will.
The healthcare provider you visit will usually file your insurance claim for you after you visit them. There are already set rates that your insurance company will pay out for each type of service, and they will pay that amount regardless of what the provider claims.
When your healthcare provider is in-network with your insurance plan, they will simply zero out the balance. Nevertheless, if they’re out-of-network, you’ll have to pay for whatever the insurance company doesn’t cover. After your insurance pays its portion of your costs, you may still receive medical bills.
Additionally, the claim could be denied altogether and you would have to pay for the entire bill yourself. If your insurance company denies your claim, it must notify you in writing and within a certain timeframe (this depends on the type of claim). As well as providing information about the appeals process, it must also provide you with contact information.