Ask the Pros: Why Does it Take So Long to Receive my Medical Bill?

So why does it seem to take so long to receive a final medical bill after an appointment? In some cases, it can take weeks or potentially months before you ever see a bill for a service you received. This is because there are numerous steps it must go through along the way. The entire process of receiving a medical bill is as follows:

1. You are seen in a clinic or hospital for services.
2. Medical codes are entered by the billing department. This timeline can vary by location and staffing.
3. The billing department sends the bill to the insurance company.
   1. The claim will be sent as a paper document or electronically within 24 hours.
   2. If a paper document, the process of going through the mail, to an inbound mail center, and through all data capture processes can take 4-6 days before it is even loaded to be processed in the insurance company’s payment system.
   3. If you saw an in-network doctor, the claim will go to the network to get pricing adjustments to determine what the insurance company will pay for. This takes between 1-5 days, ensuring accuracy and quality assurance.
4. The bill goes into the insurance company payment system. If the bill goes through auto-adjudication, it can be processed in under 24 hours. If the bill goes into pending review, it can take up to multiple weeks.
5. The insurance company will pay the doctor and the facility separately. Electronic payments take under 24 hours to process, while a mailed check could take 2-3 days to process once received.
   1. This is also the time a finalized Explanation of Benefits gets mailed to the patient and an Explanation of Payments to the provider.
   2. EOBs let the patient see what services are getting billed, and how much insurance is covering for each procedure. Pay close attention and make sure nothing is getting billed that wasn’t provided.
6. The doctor will process the payment, and reconcile their internal billing to determine any uncovered fees owed by the patient. Again, doing this electronically can be practically immediate, whereas paper bookkeeping systems could take a few days.
   This bill now gets turned over to the billing department to be mailed to the patient with a final total owed.

Overall, if all data is properly collected, it can take under 24 hours for medical bills to process when filed electronically. Paper processing takes much longer because it goes through the mail and data capture processes, etc. There are some things that can speed up this process, on both the provider and the patient’s end.

What Patients Can Do to Speed up this Process

• Make sure to bring all up to date insurance forms and authorization forms or signed referrals.
• Fully understand your health plan and any restrictions on coverage, and in/out of network providers. If your insurance plans require a copayment or coinsurance due at the time of visits, have that ready and to keep it from delaying the process.
• Respond to any prompts from your insurance company or provider quickly, so they can resolve any bill payment issues promptly.
• Owning your care may help you from getting a surprise bill down the road.

What Providers and Clinics Can Do to Speed up this Process

• Maintain and update patient records and insurance information.
• Be aware of the various requirements and procedures for different insurance companies.
  • If some insurance companies require chart notes or follow-up care notes to go along with claims, this should be set in place immediately to avoid issues down the line.
• Make quality control the highest priority. Put seamless processes in place that significantly limit errors. Double-check patient names, account numbers, services ordered versus services given, and service dates.
  Tracking claim payments or denials as part of a revenue cycle management process can help determine non-covered charges or patient responsibility amounts more quickly.
• Make quality control the highest priority. Put seamless processes in place that significantly limit errors. Double-check patient names, account numbers, services ordered versus services given, and service dates. 
• Tracking claim payments or denials as part of a revenue cycle management process can help determine non-covered charges or patient responsibility amounts more quickly. 

Based on our timeline, electronic claim submission, and processing can allow a medical bill to be adjudicated within 1-2 weeks compared to paper claims which can take eight weeks or more. With Smart Data Solutions streamlined processes, we can help providers and payers get bills processed and paid in a timely manner. Contact us now for more on how we can speed up the medical claims process.