Medical Billing Explained | Financial Services | Mosaic Life Care

The medical billing process can be frustrating if you don’t know what to expect or how to navigate it. To help, we’ve created a tutorial on understanding the medical billing process from start to finish. Let’s begin with what you need to know before you visit a clinic or hospital. First, depending on your insurance, where you receive medical care can impact what is covered. When it comes to choosing between primary care, urgent care or the emergency room, knowing your coverage ahead of time can make a huge difference in the size of your bill. Next, you need to understand who is involved with your medical visit. From the medical professionals and hospital or facility, to the insurance company and other billing agencies, each can have their own requirements or restrictions to what is covered and what is not. Be sure to ask beforehand. It’s also critical to make sure that wherever you go for care, your information on file is up-to-date, including name, address, contact numbers, birthdate and insurance card. Another consideration you need to be aware
of is that every service you receive has a code for tracking by your doctor, nurse, insurance and any other billing agencies. These codes are known as Current Procedural
Terminology or CPT codes. Always ask the doctor or nurse what the code
or codes are for the service(s) you are receiving. You also need to ask about your status code and whether you will be receiving same-day care, are under observation or are being admitted. The status code impacts what your insurance might cover. Another important aspect of coverage is understanding the difference between an authorized service and a covered service. An authorized service means a doctor or medical professional needs to get approval from the insurance company before the service or procedure is done. A covered service is already approved by your insurance. Either way, you should contact your insurance provider to see what and how much they will cover. Next, let’s talk about what you can expect
regarding payment. First, you need to be aware of in-network and out-of-network providers. An in-network or network provider is a medical
professional or facility that is approved by an insurance company. An out-of-network or non-network provider
is not in your insurance company’s network of medical professionals or facilities and can result in little or no coverage for services received. When it comes to payment, it typically involves
one of three possibilities: Copayment, Deductible or Out-of-Pocket. Copayment is charged at the time of the service you receive. The amount can vary depending on the location
and on your insurance coverage. Deductible is what you must pay before your
insurance plan starts paying. A deductible amount can vary between an in-network
and out-of-network provider. Out-of-pocket is the amount you have to pay
for a service. The amount is usually determined by adding
the deductible and co-insurance together. Co-insurance is typically a percentage of
the allowed charges based on the coverage of your plan. The result is the out-of-pocket cost. Please note that the maximum out-of-pocket
amount you have to pay can also vary between in-network and out-of-network providers. After your visit to a medical professional
or facility, you’ll typically receive an Explanation of Benefits or EOB from your insurance, followed by a service bill or bills from the medical service providers. The EOB comes from your insurance provider and details the medical services you received and the amount that was covered. A service bill comes from a billing agency and shows the amount you are responsible for paying. It’s important to note that billing will
be sent to your contact information on file. If that information is not up to date, it can result in delays and even denials of coverage. If you have any questions about coverage and payment options, ask your insurance provider. Finally, we understand that insurance may not cover everything or that you may not have insurance. If this is the case, you do have options. Mosaic Life Care has financial counselors that can explain payment options. We can help you apply for assistance and work with you to arrange a short-term payment plan, a long-term payment plan or
a financial assistance plan. For more information, please contact a Mosaic
Life care financial counselor at 844-261-7266 today.

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