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August 9, 2018

Billing and Insurance Explained

Billing and Insurance Explained

Every single time you seek medical help from any medical facility be it a hospital or emergency room, you are always requested to complete some forms with all your details such as name, residential area, date of birth and also the health insurance information. The process happens before or after treatment depending on the state of the patient. If you have a heart attack, no one will bother you with filling details while being wheeled into the emergency room. So what happens to this information provided to the emergency room?

How Does The Billing Work?

Once you provide the information on the health insurance form, a copy of your insurance card is attached and forwarded to the claims office, and medical cover claims eventually filed. A medical cover claim is essentially a bill sent to a health insurance company for the medical services a patient receives in an emergency room. The given health insurance company will then conduct an analysis and arrive at an amount they will pay for your medical treatment based on the benefit coverage the patient had been paying. Usually, the individual in question will pay a small amount of the medical bill while the insurance company pays for the rest.

Does Everyone Receive Emergency Room Welfare?

Your medical cover includes all benefits for emergency room visits. In some states, the law requires that your insurance plan must cover any visit to an emergency room of your choice without bias. The insurance company should not restrict any medical emergencies to any emergency room a patient seeks.   

Although the billing terms and conditions may sound complicated to the average patient, you are free to inquire about any terms that you may not be familiar. Once you are done filling the admission forms, the clerk will ask you to pay an estimated co-pay amount at the time of your emergency visit. Enquire on the billing options provided by the emergency room of your choice as this may help you understand the details and help you reduce the total claim filed to your insurance firm. To your advantage, some emergency rooms such as FrontLine ER incorporate in-network billing to blend-in flexibility when they are not part of your medical cover network. Be sure to ask all these details before making a decision.

Are Explanation Of Benefits Document, Bills?

As earlier mentioned, one is required to pay an estimated amount for the medical services provided at an emergency room. However, this amount may be over-quoted or under-quoted. The emergency room billing process commences as soon as the patient leaves the emergency room. You will receive an explanation of benefits in the mail you provided in the health insurance forms. This document essentially consists of the services you received in the emergency room and their related costs. Little confirmed to patients, the explanation of benefits is not necessarily a bill. However, the document is used to generate a claim to your insurance company by the emergency room’s billing department. In the case where the insurance company arrives at an analysis where you owe more than the amount already paid for the medical services, they will contact you for an arrangement to meet your financial obligation. If they owe you an amount, a refund is generated or postponed to a scheduled payment. Frontline ER has a patient care department that ensures patients are provided with billing specialists at no cost to help them understand all the options and routes they may take when following a claim.

Why Do You Receive Separate Bills from Some Emergency Room Departments?

Various emergency room departments operate differently. In traditional emergency rooms, various departments operate independently hence the reason why you may receive separate bills from the same emergency room. On the contrary, we have standalone emergency rooms that eliminate the chaos emanating from filing multiple claims for a single emergency room visit. At independent emergency rooms, they make the billing system easier by combining all bills and processing them as one. By combining, it makes it easier for both the insurance company and the patient to follow up on the claim.

Do Emergency Rooms Accept Other Payment Methods Apart From Insurance?

In the event where one isnt covered by a health insurance plan, a majority of emergency rooms accept cash, credit card, and checks. All emergency rooms are required by the law to offer emergency medical treatment despite a patient’s inability to pay for the procedure. In cases where patients come in unconscious and unable to provide payment details, the process begins when the patient is out of danger. Frontline ER works with uncovered patients to see them through a payment plan for the medical treatment received.

Bills can be tedious especially when you are required to dig deeper into the pockets. However, your health comes first. Visit an emergency room immediately you feel that you have a life or limb endangering condition. Don’t let the billing system shake you.

Emergency Care