What happens after a doctor visit? A guide to health insurance claims
Every time you go to the doctor, you are likely using your health insurance. You might have a copay, which is a fixed dollar amount (like $10) that you pay out-of-pocket when receiving medical care. Or, you may not pay until a bill arrives a few weeks later. You may be wondering, what happens between the time you see your provider and when you get the bill from their office or your Explanation of Benefits (EOB) from Wellmark?
Let's explore how your health insurance works behind the scenes, so you can be better informed when receiving health care. Take a look at how Kim's benefits worked for her when she broke her arm after a recent fall.
How health insurance claims work: From treatment to payment
When an accident happens, your health plan is here to help. Let’s use Kim as an example.
1.
Care where Kim needs it
Kim enjoys staying active. After a recent fall, she felt pain in her arm, so she went to a nearby walk-in clinic.
Knowing where to get care can be difficult but choosing an in-network provider and facility could save you money. Find in-network care near you when you log in to myWellmark®.
2.
Kim’s exam and treatment
A doctor examined her arm and ordered an X-ray. The radiologist confirmed that Kim had a broken arm. The doctor placed her arm in a cast and sent her home to recover.
3.
Kim’s claim is submitted
Because Kim chose an in-network provider, the clinic sent all charges to Wellmark after her treatment. These charges included:
- The doctor visit
- The X-ray
- The provider who read the X-ray results
4.
Wellmark pays Kim’s covered costs
Wellmark reviewed the claims and paid a portion of the costs to the providers and facilities.
5.
Kim receives her EOB
Kim reviews her EOB and sees that since the clinic handled all services in one visit, she is only responsible for her copay at the time of her visit.
Depending on your benefits, you may owe more for additional services. By logging in to myWellmark, you can estimate how much your care will cost, even before receiving your EOB.
Take control of your health care costs
Knowing your benefits, understanding your cost of care and talking with your doctor about treatment options can make a big difference. Access the tools and information you need to make sure you can save time and money the next time you get care. Get started by logging in to myWellmark® today.