Find Out How The Process Of Medical Claims Billing Works

Feb. 14, 2011 - PRLog -- The purpose of this article is to help the average person understand what medical claims are and how they work.
If you have insurance, you go to the doctor, pay your co-pay, and then the doctor’s office sends the medical claim to your insurance agency. So, the doctor’s office is submitting a medical claim to your insurance agency. Essentially, a medical claim is the remainder of your medical bill that your insurance is supposed to cover.
It’s called a claim because your insurance agency will not automatically pay your medical bills. All the information that your doctor sends to them will be taken into consideration to determine if you’re covered, and consequentially if they are responsible for the remainder of your bill.
You should really know what your insurance covers before you ever go to the doctor’s office. Usually you and your agency agree on a ratio of payment, for example, you pay the doctor twenty-five dollars and the insurance pays the remaining seventy-five dollars.
When the insurance agency receives the medical claim from your doctor, it looks at a lot of information. It compares what your contract says it is required to cover to the doctor’s notes and information about your visit or treatment. The insurance agency does this to determine if your medical procedures are covered. If your doctor did something for you or prescribed a medicine that does not fall under the umbrella of your insurance, then the insurance agency is not obligated to pay for it. When that happens, you get billed for the treatment or medications.
So, medical claims are when the doctor or hospital send your medical bill (minus the co-pay that you paid up front) to your insurance agency. They (the doctors) and you are claiming that at least a portion of your medical expenses are the responsibility of the agency.
It’s a good idea to talk with your doctor and insurance agent to find the best coverage to fit your needs. The doctor can best assess your medical needs and possibly predict the approximate cost of treatments, while the insurance agent can help you find the right coverage plan that will best cover your expenses. After you receive treatment, you may get calls from your insurance agency trying to clarify details as they process the medical claim. It’s best to be patient and stay as informed as possible.
And again, it’s very important to know what your insurance will cover before you ever set foot inside the hospital or doctor’s office, just so you won’t be surprised. There’s nothing worse than getting a huge medical bill that you thought your insurance would cover.

To learn more about medical billing please visit : http://www.hippocraticsolutions.com

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Hippocratic Solutions (http://www.hippocraticsolutions.com ) is a full service organization that offers medical claims billing, debt collection, practice management consulting and marketing services. Hippocratic Solutions is apart of the BBB (Better Business Bureau) and is known through-out the medical billing community as a leader among podiatric and hospital based physician billing. Based out of Fairfield, New Jersey we service clients nationwide with exemplary customer service and a 100% satisfaction guarantee.