Wondering what happens between the time you visit a doctor and the time you get your bill?

Going to the doctor sometimes seems like the easiest part of the equation. Find out what happens between the time you visit the doctor and the time you pay your bill.

1. You visit the doctor.
2. The doctor creates and sends a “claim” to The Alliance. 
3. We apply the agreed-upon rate to the claim for any services you received. In health care terms, we “reprice” the claim. 
4. Next, we forward it to your “claims administrator”. This all happens within less than 3 days from the day we receive your claim. 
5. Your claims administrator reviews the claim and your health care coverage and pays any amount due to the provider under your plan, except for coinsurance and deductibles. 
6. Your claims administrator sends you an “Explanation of Benefits”.
7. The doctor sends you a bill for the difference, if any, between the payment received from the claims administrator and what you owe based on your benefit plan, such as a co-pay or deductible.

Plus, don’t miss our handy dictionary of medical terms every consumer should know!