The Medical Billing Process

Many steps occur between the time you receive medical services and when you receive your bill. The medical billing process requires the coordinated efforts of your health care provider, insurance organizations(s), and the billing office/agency. In some cases, several months may pass before all parties coordinate payment and you receive a statement for the unpaid balance, unless prohibited by your health plan or other regulations. The information below may help you better understand this complicated process.

These are the typical steps taken between the time you receive medical services and you receive your bill:

1. When you go to your hospital or health care provider’s office for a medical procedure, the admitting clerk or office clerk gathers information such as: name, address, date of birth, social security number; and the name of the person responsible for paying for services (the guarantor), his/her address and employer, his/her insurance organizations(s) and insurance coverage information needed for billing the appropriate insurance organization(s). If the health care provider uses a billing agency for billing and collection, this information is shared with the agency.
2. After the medical procedure is performed, the billing office files a claim with your primary insurance organization for services. In many cases, payment is sent directly to your health care provider, not to you.
3. If your insurance organization does not pay the bill because there is a problem with the information provided, the billing office tries to collect correct information and will re-file your claim.
4. When payment is received, if there is supplemental insurance coverage (if you have secondary insurance coverage), the billing office files a claim with your secondary insurance organization for the part your primary insurance organization did not pay.
5. When all insurance has been processed, you are billed for any remaining unpaid balance, unless prohibited by your health plan or other regulations. You will receive a statement.
6. If you do not pay the balance on your statement, the billing office makes several attempts to collect from you. If you still do not make payment, a collection agency may be asked to collect the outstanding balance. If you have extenuating circumstances, for instance, if you lost your job and cannot pay your bill in full, call the billing office immediately. They can assist you in setting up a payment plan.

Why you may receive several bills for one procedure

You may receive one or more bill for a single medical procedure. How you are billed depends upon how your health care provider is set up for billing professional and technical services. For instance, when an x-ray is taken (the image to assist in determining diagnosis and treatment), the technical service consists of use of the exam room, film, equipment creating the image, and personnel using equipment and film. Sometimes you receive one bill that includes both professional and technical services. Sometimes you receive one bill for professional services and another for technical services. Here are two examples that illustrate this – both for an x-ray:

Separate bills for the professional and technical parts of a procedure, your x-ray was taken at the hospital, where health care providers bill for their professional services separately from the hospital. For this same procedure, you would receive one bill for technical services from the hospital and another bill for professional services from the radiologist. If you have a procedure performed in a hospital that requires services from a radiologist, a surgeon, a pathologist and an anesthesiologist, you would receive a separate bill from each professional, plus another from the hospital.

You could also receive a combined bill for the professional and technical parts of a procedure.  For example, your x-ray is taken in your health care provider’s office and he/she owns the equipment used. Then, billing is combined for the technical and professional parts. You would receive only one bill for both parts.

For more information or questions, please feel free to contact our Financial Counselor (517) 437-5222 or Patient Accounting Office (517) 437-8335.