Can someone explain to me the billing process for medical insurance?

Question

Like, you go to the hospital, give them your card, then what? I need a very detailed explanation please, including the names of forms used, rules, etc.

Answer 1

well... here ya go. You said hospital...

So, you go to the hospital with doctor's orders or for something previously scheduled. Your personal information, and treatment information goes into the computer, usually based on what services are expected to be performed. Throughout your stay, your medical records are updated and documented. The records will contain proof of the services being rendered. After your stay your chart & requisition forms are given to a coder. The coder interprets the charges, and applies the most appropriate medical codes to the services rendered.

In a hospital situation, this can be quite complicated. There are numerous numeric codes that have to be determined, and then applied to a hospital bill. The standard hospital claim form formerly, a UB-92, is now called the UB-04. The most relevant codes for a hospital bill are revenue codes, procedure codes, and diagnosis codes.
Revenue codes indicate the type of service. Procedure codes indicate the actual service, and procedures performed.. Diagnosis codes indicate what illness or injury associated with the stay.

There's way too much that goes into coding, and billing to give you much more than that. go to www.cms.gov. in the upper right hand corner, search for UB hospital manual. It'll give you a link to a PDF file, if you need additional info. If you have additional info available, I'd be happy to give you more detail. Like, what you're trying to understand, specifically?
I've worked in healthcare & insurance for 10+ yrs...

Answer 2

when you go to the hospital they will be the insurance company for all supplies you receive. they bill on a UB-92. any doctor that sees you during your visit will bill for his time on a HCFA-1500. they use what is called a CPT-4 code which is the procedure code and ICD-9 code that is the diagnosis code.

Answer 3

No. In the US, if you go to the hospital, you get any number of different bills from different people for their services, then your insurance instructs them to take part of it as a write-off, and then they all try to bill you for the difference anyway, and then you have to straighten all that out, and then sometimes they do it all again (double billing), and it goes on for months.

Answer 4

I cannot but your insurance company can and will. Call them they want you to be active in the process.