How medical billing works

July 29, 2013 Ryan Schuster

When you go to the store you can compare prices and choose the item that fits your budget and needs. Health care doesn't work that way. When doctors tell you that you need surgery, the cost isn't always apparent.

For those with insurance, their insurer often reimburses the medical facility for much of the initial charge before you get your bill. But sticker shock is still common when people get a hospital bill. How much you pay depends upon whether or not you have insurance and the details of your insurance plan. For example, many people have deductibles they must pay before insurance kicks in and pays for as much as 80 percent or 90 percent of covered services. Our members receive detailed Explanation of Benefits statements, breaking down how much we were billed by the hospital, the amount of their deductible or co-pay, how much we reimbursed the hospital and how much the member is responsible to pay.

Insurance companies negotiate rates with medical facilities to provide savings to their members. Because of our status as the dominant insurer in the state, Blue Cross Blue Shield of North Dakota is able to offer our members the best rates from North Dakota hospitals.

Along with other Blue Cross Blue Shield plans, we are leading a number of consumer transparency initiatives in North Dakota to provide members with more information about provider quality through the Blue National Doctor and Hospital Finder, allowing members to view and post online comments about doctors. We are also collaborating with other Blues plans to improve and update the National Consumer Cost Tool, to give members like you more info to help calculate out-of-pocket costs. We are also working with doctors and hospitals in the state to start reimbursing them more based on quality and less on quantity of services provided.