Eight Questions Your Patients Should be Asking You

Why This Topic Matters

Understanding these common patient concerns can help practices communicate more clearly about coverage, claims, and billing statements, reducing confusion and unnecessary disputes.

Article Sections

1. Do I really have Medicare?

   Discusses how patients may be covered under different Medicare-related plans and why identifying the correct plan matters for participation and coverage questions.

2. When is it important to open the mail from my insurance carrier?

   Covers common insurer requests for patient information and the general reasons those requests may affect claims processing.

3. Is my Doctor really in my network?

   Explains issues related to network participation, health insurance exchange products, and differences among carrier plan offerings.

4. Why did my doctor collect a $50 copay, when the EOB states I should only pay $46?

   Addresses patient questions about cost-sharing, contractual payment amounts, and differences between office collection and insurer statements.

5. Why are there 5 different bills for my surgery?

   Describes the separate billing components that can be associated with a surgical episode of care and why patients may receive multiple claims or bills.

6. Why do I have a deductible and a co-pay for the same visit?

   Reviews how office visits, diagnostic services, and other charges can trigger multiple forms of patient responsibility under a health plan.

7. Why does the explanation of services on my EOB indicate a 45 minute visit, when I was only in the doctor's office for 20 minutes?

   Introduces general concepts behind evaluation and management reporting, visit time, and visit complexity as reflected on claim statements.

8. I was treated by Dr. Smith; why does my insurance statement list Dr. Doe?

   Explains how practice business entities and employment relationships can cause a different name to appear on insurance statements.