We get this question a lot. Prior to a doctor’s visit, you may have asked the office whether they would accept your health insurance, and they confirmed that they would. But then, a few weeks later, you get a bill from your doctor’s office for some amount of money for the visit.
What gives? Didn’t your doctor’s office say they would accept your health insurance? Why are they coming to you for more money?
Well, the truth is that your doctor’s office may accept payment from any number of health insurance companies, but that doesn’t not necessarily mean that it considers whatever payment that it receives from your health insurance as full and final payment for the services your doctor has rendered.
Health insurance companies have a maximum dollar amount that they will pay for each procedure, usually called the “reasonable and customary charges.” If your doctor’s office charges more for a procedure than your health insurance company’s reasonable and customary charge payment maximum, it will look to you to pay the balance, whatever it is.
If you can, before you go in for a doctor’s visit or procedure, ask your doctor’s office whether they will accept your health insurance payment as full and final payment for services. If it does not, ask if you can have an estimate of the full charges and call your health insurance carrier to find out what it’s reasonable and customary charges may be. at least you will be more prepared when you get that bill in the mail!
Have you ever been slammed by unexpected medical bills? Tell us about it in our forum!
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- The Cuts Are the Deepest: Effects of Medicaid Cuts on Doctors and Patients
- Keeping Medical Care Affordable: “Reasonable and Customary”