Some Charges May Apply
Just because a medical provider offers direct billing doesn’t mean a patient won’t have to pay out of pocket. Many plans require a co-payment, which is due at the time services are provided. After that, each claim is assessed by the insurance provider. The insurance company will send out an explanation of benefits that details what the facility charged, what the insurance company paid,and what if anything the patient owes. This isn’t a bill; however, the patient is responsible for settling with the medical provider at that point.
If the insurance company says it won’t cover the procedure or won’t cover the entire cost, the medical provider will then bill the patient for the remainder. Insurance companies can take months to process claims, which means sometimes the news that the patient is responsible for the charges can come long after the appointment took place.