For Patients

1. Why did I receive a bill if I have insurance?

Having insurance does not mean services are covered at 100%. Your financial responsibility depends on your specific plan and may include:

• Deductible

• Copay

• Coinsurance

• Non-covered services

• Out-of-network penalties

Insurance processes claims according to your plan benefits — not necessarily what the provider charges.

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2. What is an Explanation of Benefits (EOB)?

An Explanation of Benefits (EOB) is not a bill.

It is a statement from your insurance company explaining:

• What was billed

• What was allowed

• What insurance paid

• What portion is your responsibility

Your medical bill should reflect what your EOB indicates as patient responsibility.

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3. What does it mean when my claim is denied?

A denial does not always mean something was done incorrectly.

Common reasons include:

• Deductible not met

• Policy exclusion

• Missing information

• Authorization requirements

• Medical necessity review

Some denials can be appealed. Others are based strictly on plan limitations.

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4. If prior authorization was approved, why didn’t insurance pay?

Prior authorization confirms a service meets initial review requirements. It does not guarantee payment.

Claims may still be subject to:

• Benefit exclusions

• Deductibles

• Coinsurance

• Documentation review

• Eligibility changes

Authorization approval and claim payment are two separate processes.

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5. Why didn’t my secondary insurance cover the remaining balance?

Secondary insurance does not always eliminate patient responsibility.

It depends on:

• Coordination of benefits rules

• The secondary plan’s deductible

• Whether the service is covered under the secondary plan

• The amount allowed by the primary insurance

Each policy processes according to its own benefit structure.

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6. How do I know if my bill is correct?

To review your bill:

1. Compare it to your EOB.

2. Confirm insurance processed the claim.

3. Verify that deductibles and coinsurance match your plan.

4. Contact your billing office if something does not align.

If you are unsure, we provide guidance to help you understand what to review and what questions to ask.

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7. Can you guarantee my claim will be paid or overturned?

No.

We provide education, clarity, and strategic guidance — but insurance companies make payment decisions based on your policy and their review criteria.

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For Medical Practices

8. Why are we seeing repeated denials for the same service?

Repeated denials often stem from:

• Coding alignment issues

• Documentation gaps

• Payer policy updates

• Authorization workflow problems

• Benefit verification errors

We help identify root causes and implement process improvements.

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9. How can we reduce patient dissatisfaction with billing?

Patient frustration often comes from:

• Benefit misunderstandings

• Poor financial communication

• Insurance verification inaccuracies

• Secondary insurance processing delays

Improving transparency and workflow clarity significantly reduces complaints.

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10. Do you provide legal advice?

No. We provide educational and strategic guidance related to billing processes and insurance navigation. We do not provide legal advice or guarantee outcomes.