• Ronnie Shalev, MD

Understanding Your Medical Bill



Nothing creates more anxiety than getting a medical bill in the mail. Medical bills are notoriously difficult to make sense of and to understand.


If you only received a summary bill, do not blindly pay it. You should verify the bill is coming from a legitimate source and request an itemized bill from the hospital or medical professional . This ensures that you know exactly what you’re being charged for. You will also need a detailed EOB (explanation of benefits) from your insurance provider in order to get the full picture of charges and payments.


In this blog series, I will break down what each term means and in next week’s blog I will help you check for common errors in your medical bill.


What do these mean?


Member Information: This shows the health insurance member’s full name and ID number.


Provider Name: The name of the hospital, physicians’ office, or healthcare professional you visited during your appointment.


Date of service: The date you received the medical services, procedures, or supplies.


Deductible: is a specified amount of money that you are required to pay before the insurance company will pay the claim.


Copayments: A fixed amount you pay for a covered health care service after you've paid your deductible


Numbers, Numbers, Numbers, Oh My!


These identifiers look like a bunch letters and numbers and might resemble some secret code out of a spy movie, but they serve a purpose, are used often, and should be understood.


Patient Account Number: This is the unique identification number used by your healthcare provider to track your account.


Claim Number: This unique identification number is used by your insurance provider to track your account.


Service Code: This identifies the specific services, procedures, or supplies you received from a healthcare provider.


Bill Breakdown


Total Amount: This dollar amount shows the full cost of the procedures or services.


Not Covered: This is the amount your health insurance does not cover. This is where an EOB (explanation of benefits) is helpful. You can figure out why something was not covered. More on this topic next week...


Reason Code Description: This code provides the reason(s) why your insurer did not cover a charge.


Covered by Plan: This is the total amount your health insurance provider has saved you by having negotiated rates.


Deductibles and Copayments: These are adjustments added based on the deductible and copay features of your insurance plan.


Total Net Payment: This includes the full dollar amount your insurance company has paid to your healthcare provider.


Total Patient Responsibility: This is the total amount YOU owe your healthcare provider.


Checks Issued: This section gives you a detailed record of the payment transactions from your insurer to your healthcare provider. These lists generally contain the payee’s name, check number, and check amount, for tracking purposes.


Now that you can understand the medical bill terminology better, you will be more equipped to spot errors. In next week's blog I will cover how to spot an error in your medical bills.


Don't worry, MediBookr can also help. By logging into your app, you will automatically know how much of your deductible has been met. Our advocacy team can also shed light on covered procedures, pricing information, strategies for healthcare savings, medical bill review, and more! Go to www.medibookr.com


-Dr. Ronnie Shalev is the Chief Medical Officer at MediBookr and is a Board Certified Emergency Medicine physician.

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