Some Basics on Billing Insurance Companies
There's a wealth of information on our Healthy Bytes Resources page as well as our blog, but here's a high-level explanation of some of the most common questions and areas of confusion related to being contracted with an insurance company.
Help! Insurance feels like a new language I have to learn!
Insurance is confusing even when you speak its language; when you’re learning the vocabulary, it’s a nightmare. To make things easier, we've put together a primer on insurance and healthcare jargon.
What Does It Mean That I’m an “In-Network” Provider?
Once you’re contracted with a plan for a given insurer, you're assigned an “effective date” and are “In-Network” with that insurance company when you render care for its members.
At this point, your name is posted in their directory and recommended to their patients. This means you'll have more exposure and reach a higher volume of clients. Additionally, patients are more likely to seek you out instead of you having to look for them.
How Much Will I Get Reimbursed? What is Balance Billing?
On average, the reimbursement process for insurance companies takes about one month from claim filing to receipt of reimbursement. Typically, you'll bill one of two CPT codes and use units (generally, 1 unit = 15 minutes) to indicate the duration of the encounter.
The amount you’ll receive from the insurance company is called the “allowed amount” and may differ from the amount you billed to the insurance company. The allowed amount will also vary across insurance companies, plan types, and the region or state in which services were rendered.
Depending on the stipulations of your contract, you have two options at this point: write-off the difference as a contractual obligation or bill the patient the difference. The latter is known as balance billing and is often prohibited by your contract with the insurance company. For more in depth information on these topics, take a look at some of our blog posts which provide much more detail.
For more information on how billing with units works, take a look at our blog post that covers all the pertinent information you’ll need to know for dietetic billing with units.