Published On: Thu, May 20th, 2021

Everything You Need to Know About Healthcare Reimbursement?

Receiving medical treatment is often a difficult experience for anyone. You are likely so focused on your health and your immediate future that you don’t pay too much attention to the organizational side of things. Knowing a bit more about how charges for treatment works and how healthcare payments are made can help you remain in control of your healthcare.

photo/ Darko Stojanovic

What is Healthcare Reimbursement?

Healthcare reimbursement is the payment that is provided to a doctor, hospital, clinic, or any other form of healthcare provider in return for performing a particular medical service. Usually, patient reimbursement does not come from the individual but from a government or insurance provider, depending upon your nationality and location. If you are living in a location where you pay for the healthcare you receive, what you pay will depend on your insurance coverage. If your healthcare plan does not cover specific medical treatments, then you will be responsible for reimbursement. It is called a reimbursement, rather than simply a payment, because the process of exchanging money usually occurs after a patient has received treatment.

What are the Different Types of Healthcare Reimbursement?

Once you have received medical treatment, your insurance provider will be sent a bill for your medical costs. The charge made for your treatment will either be a set amount (which is dictated by Medicare) or a fee that your private insurance company has arranged. However, just because your treatment is covered by your insurance that does not mean that you won’t have to pay any money for treatment.

You might be expected to pay Co-Pay, or as it is otherwise known, pay for Co-Insurance. Co-Pay is a clause in your insurance policy that states that you are required to pay a portion of medical expenses out of your pocket, and your insurance provider will pay the rest. The Co-Pay charge is usually a fixed amount, such as a percentage of the total bill.

Even if your main treatment is covered in your insurance policy, you might have to pay for other services or procedures. If you have health reimbursement arrangements, otherwise known as HRAs, your employer will reimburse you for your out-of-pocket medical expenses. This is particularly useful when your healthcare policy has a high deductible.

Understanding Medical Bills

When you are looking to take more control over your healthcare, you must understand your medical bills. There are three pieces of paper you will need to consult to better understand your medical bills. One of these pieces of paper will outline the services performed, and this is usually given to you when you leave the doctor’s office. You will also have a bill sent by the healthcare facility, showing a list of services and charges of these services. You will also receive an explanation of benefits from your insurance or payer.

There are different methods involved in understanding how to read your medical bills. Firstly, you will need to learn what the CPT and ICD codes are. You will also learn more about the charge for the services you received and compare this number with Medicare to see if the pricing is fair.

Learning more about your healthcare reimbursement and understanding how to read your medical bills can help you feel more empowered as it allows you to take control of your own healthcare arrangements better.

Author: Carol Trehearn

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