Health Insurance Articles
What To Do If You Receive A Bill That Should Be Covered By Your Health Insurance Coverage
2010-02-14
Whether it is an HMO, PPO, or POS, almost everyone has some type of health insurance coverage to help pay the bills in the event of an emergency or critical injury, and even to simply help with regular checkups and prescription drug purchases. But what happens if a bill arrives in the mail that the health insurance should have paid? The bill could be quite substantial, and many people are not sure how to best proceed. Should the client pay it and contact the company after the fact to rectify the situation? Or should it simply be forwarded on to the insurance provider? The first thing to do if this occurs is to call the health insurance provider directly and see what exactly the situation is.
There are several likely circumstances if a bill arrives at a home unpaid. The first is that the health insurance policy purchased requires that the client pay any bill first, and then submit paperwork to the company to be reimbursed. While this will typically happen at the time of the appointment or procedure, there are cases where a client will receive a bill after the fact. The second possibility is that the service used was outside of the health insurance coverage of the plan. In an HMO, for example, a provider used outside of the allowable network will not be covered at all, and the entire cost will rest with the client. In a PPO or POS plan, the health insurance company may pay a portion of the cost, but that will be determined by their schedule of benefits, and again, they may require the bill to be paid in full first.
Another possibility is that the deductible for services has not yet been paid. Many health insurance policies require that a minimum deductible be paid by the client before they will begin covering any services for that year, and this deductible typically ranges from $500 to $1000. It is also possible that the bill arriving may have been a mistake on the part of the service provider or insurance company. In any event, the most important thing to do is call the insurance provider directly and determine exactly where the bill came from, and if it needs to be paid in full. Do not immediately pay it, as that could result in those funds never being recovered, but also do not simply ignore it, as that could result in bill collectors or a default on future insurance claims.
While having an unexpected bill arrive can be stressful, the situation can often be quickly remedied. A good insurance provider should be able to offer direct and specific advice.
