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Understanding Some Of The Financial Terms On Your Medical Bill

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Medical billing is an extremely complicated process that requires information from many different sources. The information is used to create the bill and it is sent to your insurance company. The leftover balance after the insurance payment is your responsibility. If you want to make sure that you are billed correctly, especially if you need to enter into a payment or managed billing agreement, then keep reading to learn about some of the terms you will see on your bill that may be a bit confusing to you.

Actual Charge

The actual charge is the amount that your physician charges for each procedure that is scheduled and performed. You may also see this charge for medication and devices that have been used or implanted into your body. This is typically the highest charge or price you will see on the bill. It is typically more than the insurance company is willing to pay. This is normal, and the insurance company will negotiate prices or offer a set rate for each service that the physician supplies. 

Underneath the actual charge, you will likely see the adjustment. This is the discounted amount that the doctor or medical center has removed from the bill and will not charge you. There is often a large difference between the actual charge and the final bill amount due to the adjustment. If you are having an issue making payments, then your doctor can increase the adjustment so that you need to pay less overall. 

When all discounts are applied, you will see a balance bill. This balance bill can be broken down further into increments if you desire a payment plan, but it is essential your "final" bill or the amount you are responsible for. 

Estimated Insurance

If you receive paperwork in the mail soon after a stay in the hospital, then you may see a line that labeled estimated insurance. This is exactly what it sounds like. It is an estimate of what your insurance company will agree to pay. This gives you a good idea of what you may be responsible for afterwards. While this is true, the actual payment may be higher or lower and an adjustment will then be made to your final bill.

If for some reason your insurance company is unwilling to pay a portion of your bill, then you have the option of discussing a further discount with the hospital. Specifically, something called charity care can be arranged. This reduced the fee for individuals who have a financial need. Contact a company, like Chart Perfect, for more info.