Understanding Healthcare Insurance and Billing
Healthcare billing and insurance can be confusing. The following are suggestions to help you understand your insurance coverage and medical bills.
If you are unable to pay your medical bill for services provided by Cheyenne Regional, or if you have questions about your medical bill, please call Cheyenne Regional’s Business Office at (307) 996-4777. The office is open Monday through Friday, 8 a.m. – 4:30 p.m. You may be eligible for state, federal or local funds that cover hospital or doctor’s bills. Cheyenne Regional also has charity care funds available for those who qualify. If you aren’t eligible for assistance, we will work with you on an affordable payment option.
Know what your insurance policy covers.
It’s important to know which medical procedures your insurance policy covers, which procedures are not covered, which procedures require pre-authorization and which procedures are only covered after you pay a deductible. Your insurance policy handbook should also explain what co-pays and co-insurance you are required to pay. If you aren’t sure what’s covered, call your insurance company. It might help to have a list of questions prepared ahead of time.
Make sure your insurance information card is up to date.
An old or inaccurate insurance card can create medical billing problems. Make sure your doctor’s office or hospital has the most up-to-date copy of your insurance card.
Sometimes employers fail to pass on their files of new employees eligible for coverage to their insurance provider/health plan.
Make sure you are covered. Check with your employer’s benefits manager. If you have recently been hired or have changed plans, double-check your insurance coverage with your benefits manager.
Make sure your doctor or healthcare facility is included in your insurance company’s network.
In most cases, your insurance company will only pay for medical procedures and services provided by doctors or healthcare facilities that are included in its network of providers. If you receive care from a doctor or facility that is not in that network, you may be required to pay more out-of-pocket or may be denied coverage altogether. Verify your insurance coverage ahead of time with your doctor’s office or hospital and your insurance company. This may not be possible in the event of an emergency. In that case, call your insurance provider as soon as possible.
Read the Explanation of Benefits (EOB) from your insurance company.
Your insurance company will send you an Explanation of Benefits (EOB) for every medical procedure you have and every medical provider you see or receive a service from. The EOB is not a bill, but it’s still important that you read it carefully. It will tell you what you are being charged, what your insurance is paying and what you have to pay. It is important to compare the EOB with the bill you receive from your doctor’s office or hospital. If there is something you don’t understand or agree with, call your insurance company as soon as possible. Some insurance companies no longer mail out an EOB. Find out if your insurance company is one of these, and, if so, how you can obtain an EOB.
Make sure your bill is actually a bill.
What appears to be a bill may actually say “$0 balance due,” “your commercial carrier has been billed,” “this is a statement” or “this is not a bill.” No payment is required at this point.
Carefully read every bill or statement from your doctor’s office, insurance company or hospital.
Do not assume that your insurance plan will take care of it for you. Call the telephone number on the statement with any questions. Please note the following main parts of your medical bill:
- Statement date—The date the billing statement was printed by your healthcare provider.
- Previous statement balance—The total amount of unpaid medical services before you received the current statement. If you have paid all previous bills in full or this is the first time visiting the doctor or healthcare facility, the balance will be “0.”
- Description—List of medical services.
- Account balance—The amount of money you owe your healthcare provider.
Ask for the name and phone number of any insurance representative you talk to.
You can also write a letter. Insurance companies must respond to formal written appeals.
Call immediately if you notice a medical billing problem or if you do not understand the bill.
The sooner you bring it to someone’s attention, the easier it will be to track and resolve. Keep all invoices, receipts, billing statements, bills, copies of checks, copies of credit card statements and interactions with insurance and billing personnel in chronological order in case you need to refer to them at a later time.
