How Does Hospital Medical Billing Work?


Quick Answer

Health care providers file hospital medical bills with the insurance company after a patient pays a copay, deductible or coinsurance to the hospital, Regence claims. After the insurance approves or denies the claim, the medical provider bills the patient for any remaining balance.

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How Does Hospital Medical Billing Work?
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Full Answer

The hospital billing process begins with the patient paying up front for any medical costs associated with a particular insurance plan, Regence explains. These medical costs include a copay for certain medical services, a deductible for the overall insurance plan or a coinsurance amount. After the patient pays these costs, if applicable, the hospital sends a bill to the insurance company with information about what medical services were performed in the hospital. When the insurance company pays the accepted amount on the bill, it sends an explanation of benefits to the patient describing how much the insurance company paid. The patient is responsible for any remaining balance after the insurance company pays its portion.

Medical billing specialists use medical coding to tell insurance companies about the services rendered in the hospital, the American Academy of Professional Coders states. These codes correspond to physicians' diagnoses of patients and the treatments used in the hospital.

Hospital billing procedures depend on whether patients have health insurance coverage, Cedars-Sinai adds. Medical facilities bill patients directly when patients do not have medical insurance coverage.

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