Do insurances only pay a set % of charged? Because in that case hospitals would just charge whatever arbitrary amount they wanted.
I think insurances set hard limits on paying individual types of tasks and procedures. Hospitals and doctors bill whatever they want, insurance pays X that’s allowed, tells the insured what they owe, and the rest is written off by the doctor because no one is obligated to pay it.
This is what procedure codes are for. Technically, they only apply to Medicare but im sure insurance uses them. As far as I know there is a catalog of every possible procedure and the insurance company has an agreement with the hospital that they will pay a specific amount for each. There are also loose guideleines as for what procedures are appropriate in what circumstances.
Your hospital send insurance a bill with procedure codes, then insurance decides whether the procedure appears appropriate and in theory pays
That’s why one of the first things to try is for the medical personnel to re-code your record. maybe there’s a similar one that’s more appropriate to the illness or to what the hospital did
Do insurances only pay a set % of charged? Because in that case hospitals would just charge whatever arbitrary amount they wanted.
I think insurances set hard limits on paying individual types of tasks and procedures. Hospitals and doctors bill whatever they want, insurance pays X that’s allowed, tells the insured what they owe, and the rest is written off by the doctor because no one is obligated to pay it.
This is what procedure codes are for. Technically, they only apply to Medicare but im sure insurance uses them. As far as I know there is a catalog of every possible procedure and the insurance company has an agreement with the hospital that they will pay a specific amount for each. There are also loose guideleines as for what procedures are appropriate in what circumstances.
Your hospital send insurance a bill with procedure codes, then insurance decides whether the procedure appears appropriate and in theory pays
That’s why one of the first things to try is for the medical personnel to re-code your record. maybe there’s a similar one that’s more appropriate to the illness or to what the hospital did