You have insurance but you still received a bill Why?

Answer 1

There are a few possibilites: 1. The caregiver was paid but you didn't pay your co-pay fee. A co-pay is an amount a patient may have to pay in addition to what the insurance company covers. Co-pays can range from $0 to many thousands, depending on your insurance policy and what procedures were performed. 2. The procedure you had was applied against the insurance policy's deductable amount. It's pretty common that the first few hundreds or thousands of dollars of healthcare every year come from the patient, until the deductible amount is reached, and the insurance company takes over from there. 3. You've exceeded the maxium your policy covers. If your policy maxes out at $50,000 per year (for example), any bills in excess of that amount go to you. 4. The insurance company has taken their time to pay your care provider and they've decided to bill you. If this is the case, call them and tell them to bill the insurance company. Most caregivers will do this for you. 5. You've had a procedure your insurance company thinks it doesn't cover. This can be well-patient visits, experimental procedures, pre-existing conditions, non-essential procedures (elective plastic surgery for example is not covered by insurance). 6. Your caregiver or, more likely, your insurance company either lost the paperwork or failed to "code" your procedure properly. In other words, they typed it in wrong and whatever they typed in isn't something the insurance company pay for. It's pretty common practice for insurance companies to deny claims, then work out the details. My advice would be to call up your caregiver's billing office and ask them to tell you what they think is happening. If not that, read your most recent insurance statements -- they'll tell you what they didn't want to pay, and why.