Balance billing occurs when a healthcare provider bills a patient for the difference between the provider’s charge and the amount paid by the insurance company. This practice can lead to unexpected medical bills and is a common source of confusion for patients. Understanding how balance billing works, when it is allowed, and when protections apply … Read more
Out-of-pocket maximums place an annual limit on how much a policyholder must pay for covered healthcare services. Once this limit is reached, the insurance plan typically pays 100 percent of allowed costs for the remainder of the plan year. Understanding how out-of-pocket maximums apply to health insurance claims helps individuals anticipate when cost sharing will … Read more
Copayments and coinsurance are two common forms of cost sharing that determine how healthcare costs are divided between the insurance company and the patient. While both affect what patients pay, they work differently within the health insurance billing process. Understanding how copayments and coinsurance apply to claims helps individuals anticipate costs and read billing documents … Read more
Deductibles play a major role in how health insurance claims are processed and how much patients pay for medical care. While many people understand deductibles in theory, confusion often arises when claims are filed and payments are calculated. Understanding how deductibles affect health insurance claims helps individuals anticipate costs and read claim documents accurately. What … Read more
Prior authorization is a requirement used by health insurance companies to review and approve certain medical services before they are provided. This process is intended to confirm that a service is medically necessary, covered under the policy, and provided in the appropriate setting. Understanding how prior authorization works helps patients avoid claim denials, treatment delays, … Read more
Health insurance claim denials are a common source of confusion and frustration for policyholders. A denied claim means the insurance company has decided not to pay for some or all of the services billed. Understanding the most common reasons claims are denied helps individuals prevent issues, respond effectively, and avoid unnecessary out-of-pocket costs. What a … Read more
Health insurance claims are handled differently depending on whether care is received from in-network or out-of-network providers. This distinction affects how claims are submitted, how much the insurance company pays, and how much the patient may owe. Understanding the differences between in-network and out-of-network claims helps individuals anticipate costs and avoid unexpected medical bills. What … Read more
Healthcare providers play a central role in the health insurance claims process. In most situations, providers handle claim submission on behalf of patients, ensuring services are properly documented and sent to insurance companies for payment. Understanding how providers submit health insurance claims helps patients know what happens after care is received and why delays or … Read more
Medical bills and Explanations of Benefits (EOBs) are often confused, but they serve very different purposes in the health insurance claims and billing process. Understanding the difference between these two documents helps patients avoid overpaying, recognize billing errors, and know when and how much to pay. What a Medical Bill Is A medical bill is … Read more
An Explanation of Benefits, commonly called an EOB, is a document sent by a health insurance company after a medical claim is processed. While it often arrives with confusing numbers and codes, the EOB is one of the most important tools for understanding how a health insurance claim was handled. Knowing how to read an … Read more