Why did I get a bill from a medical facility if I have health insurance?

Having health insurance does not mean you will never receive a bill from a medical facility. There could be many possible reasons that you received a bill from a medical facility. Here are a few possibilities.

• You went to an out-of-network doctor or facility. Going to facilities or medical professionals who are not within your plan's network of providers typically costs more than staying in-network. Your plan may require that you pay the difference between what would have been the costs at an in-network provider and the costs you incurred at an out-of-network provider.
• You have not paid your copayment. Your copayment is a fixed amount you pay for a covered health care service. Usually you pay your copayment at the time of service, but in certain instances, such as if you are seeking emergency care, you may be billed for your copayment after your visit.
• You have not met your deductible. Your deductible is the amount you agree to pay for covered health care services before your health insurance plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve paid $1,000 for covered services. Some plans pay for certain health care services, such as preventive screenings and exams, before you’ve met your deductible.
• Your bill is for coinsurance. If your health plan includes coinsurance, you agree to pay a share of the costs of a covered health care service, calculated as a percentage (for example, 20 percent) of the allowed amount for the service. You pay coinsurance after you’ve met your deductible. For example, if your health plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your 20 percent coinsurance payment would be $20.
• The insurance company denied payment or only paid part of the bill. Insurance companies may believe a procedure or test was unnecessary, or they may have set payments for tests and procedures that are below the charges of the facility. Generally the patient has to make up the difference. Note that you may be able to appeal such a decision.
• The medical facility made a mistake. Billing mistakes happen. It is important to review your bills carefully to make sure you were charged only for the services you received, and that you weren't charged more than once for any service.

If the reason you received a bill is still unclear, call your insurance company at the customer service number on your medical ID card, or call the facility and speak to someone in the billing department.