This blog exists for one reason: to make medical billing and insurance understandable.
Why Is Medical Billing So Complicated?
Medical billing isn’t just a bill. It’s the result of multiple steps happening behind the scenes:
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A provider documents your visit.
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Diagnosis and procedure codes are assigned.
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A claim is submitted to insurance.
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Your insurance processes the claim based on your specific plan benefits.
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An Explanation of Benefits (EOB) is generated.
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Then — and only then — is a patient statement produced.
At each step, there are rules. Policies. Coding guidelines. Contractual adjustments. Deductibles. Coinsurance. Coordination of benefits.
And here’s the important part:
Your insurance policy determines what gets paid — not the provider.
That’s where much of the confusion begins.
What Patients Often Don’t Realize
Here are a few truths that surprise many people:
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Having insurance does not mean services are covered at 100%.
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“Covered” does not mean “free.”
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A denial does not always mean something was done incorrectly.
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Your deductible must be met before many services are paid.
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Secondary insurance does not automatically eliminate patient responsibility.
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Prior authorization approval does not guarantee payment.
Insurance companies process claims according to the benefits your employer or plan selected.
And unfortunately, those benefit details are rarely explained clearly at enrollment.
What You’ll Find Here
In this blog, I’ll break down topics like:
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How to read your Explanation of Benefits (EOB)
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What a deductible really means
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Why prior authorizations don’t guarantee payment
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Why claims get denied
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How secondary insurance works
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What “medical necessity” actually means
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When you should appeal — and how to do it
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How to talk to your billing department effectively
I’ll also share insight into how medical practices work behind the scenes so you understand what’s happening before that bill ever reaches your mailbox.
My Goal
Healthcare is complicated enough.
Understanding your benefits shouldn’t be.
My goal is to replace confusion with clarity — to help you feel informed instead of overwhelmed, and confident instead of frustrated.
Because when patients understand their benefits, conversations change. Anxiety decreases. And decisions become more empowered.
If there’s a billing or insurance topic you’ve always wanted explained in plain language, let me know.
We’re going to decode this system — together.
— Connie