Craig Guillot
Visit a doctor’s office or a hospital these days, and it could take awhile to find out how much you owe. With the back-and-forth among your health care providers, your insurer and medical billing companies, it’s not uncommon for patients to wait months to receive all of their medical bills.
But with all of our advanced technology and instant access to information, why does it take so long?
We reached out to several health insurance companies for comment but didn’t receive any responses.
Industry observers pin the blame on a complex web of communication among various parties. Others say there’s no rational reason.
Multiple parties involved
Often, several players are involved in generating a medical bill. Illene Ferrell, president of Advanced Billing Professionals, a company that provides medical billing services, says billing typically involves your health care provider, your health insurance company and, in many cases, a third-party billing company.
When you visit a doctor’s office or hospital, it typically checks your insurance information to find out what’s covered and what’s not. After performing services, the office or hospital will submit a claim to your insurance company, either on its own or through a billing company. Patients usually are responsible for a deductible and possibly a co-pay for the service provided. While deductibles usually are paid upfront, co-pays often are billed after the visit.
“It usually depends on whether the doctor is in the network and the rules of the insurance company. It can really differ depending on the health care provider,” Ferrell says.
That final bill, or collection of the co-pay, is what leaves many patients waiting weeks or months. And when several services are delivered during one visit, several bills could arrive over a lengthy period.
John Metz, chairman and CEO of Just Health, a health care consumer advocacy group, says a patient could receive a bill from a doctor, a lab and even a second doctor who read the test results. Combine that with complications, such as delays, missing invoices or late billings by health care providers, and it can leave some patients waiting a long time to find out how much they owe.
Hospital complications
Billing can be much more complex at hospitals. When a patient visits a hospital for a more complex procedure, such as cancer treatment, it can involve several departments or providers, many of which bill individually. That’s why patients may sometimes receive one bill from the hospital, another from the anesthesiologist and yet another from the radiology department.
And to make things even more complicated, billing procedures vary by hospital — some may send one bill immediately, others may send numerous bills over the course of several months.
“When you got to a hospital, all kinds of people come out of the woodwork wanting to bill you. You might get the facility bill immediately but might not get the anesthesiologist or other bills for months later,” Palmer says.
Jennifer Nichols, vice president of Advanced Billing Professionals, a medical billing and claims processing company, says a number of other factors can cause delays. These could include incorrect processing or coding (how insurers identify procedures or expenses) that’s rejected by an insurer, or even disorganization and delays at a doctor’s office or hospital.
“If the insurance company sends something back, it can cause delays. Some doctors do their own billing as well, and there can be inefficiencies,” Nichols says.
No ‘rational reason’ for delays
Paperwork shuffling between insurers, health care providers and medical billing companies still might not fully explain why some patients have to wait months to receive a bill or bills. Metz says there’s “no rational reason” for such delays to last months or even more than a year. He says health care providers, insurers and billing companies have the technological capabilities to generate bills within days of a hospital stay or doctor’s visit.
Unfortunately, there isn’t much patients can do to speed up billing other than to call their health care providers and insurance companies. Nichols says you can request a bill, but you can’t be assured that it contains all of the charges. Most insurers let patients access their claims online.
“We don’t like to see patients wait. The only thing patients could do is check with their insurer to see what has been submitted. But if the (health care providers) haven’t submitted all the bills, you won’t know what else is out there,” Nichols says.