Insurance Billing Explained

The world of insurance is complicated and I don’t think that is done on accident. Who really wants to take the time to understand how Doctor’s office’s bill for their services. Most people just blindly pay their premiums and just assume that insurance companies won’t take advantage of them, well in 2018 insurance companies posted record profits. Maybe its time we start educating ourselves on what we are paying for and what insurance should be. The system has now become so complicated that health care practices often employ individuals that specialize in billing and coding to ensure that they are collecting from insurance companies all they can.

All Doctor visits are divided into different levels based on the complexity of the problem the patient is being seen for. This complexity is not always defined by the actual complaint but instead on how many questions the provider asks or how many body parts are examined. It also depends on if the provider has seen the patient before or if they are new to the practice. The levels are 1 – 5, with a level 5 visit being the most complicated. Most office visits are billed at either a level 3 or 4. A simple nurse visit is typically a level 1. Based on this level is how much the insurance company will be billed for the provider’s services. But what a provider bills and what the insurance company will pay are different. Insurance companies have what are called contracted rates which are always lower than what is billed.

insurance bills

So how does this affect the patient? Well, when providers are already getting paid discounted rates for the work they do they have to make that difference up by seeing more patients. Thus their days are filled with patients each getting about 15 minutes of the provider’s attention. Providers spend less time with the patients and never really get to know them. How many times have you called to get an appointment with your Doctor only to be told their next appointment is 3 weeks away. Often additional or unneeded tests are ordered because this will bump up the level of billing. These additional tests are often at the expense of the patient due to their high deductibles they become responsible for the costs.

At Apex we are different. We remove the restrictions and headaches associated with the insurance industry. Our members pay one low monthly fee and then can be seen as many times in a month as medically needed. Our patients always will get same day or next day appointments and our appointment times are at a minimum of 30 minutes. We want to give the patient time to discuss all their concerns and still have plenty of time to go over the plan so there is no confusion.