You pay your deductible, copays or coinsurance directly to the health care provider (such as a doctor or hospital). The provider then bills the insurance company for the rest of the amount due. Your insurer will help you figure out what, if any, you owe. Here's an outline of how it usually works.

  • Copay: If applicable, you'll pay a copay directly to the health care provider at the time of service.
  • Insurance billing: After your medical service, the provider will send a bill to the insurance company, detailing what services were performed.
  • Insurance payment: The health insurance company reconciles the doctor's bill against your coverage and pays its share, if any, to the provider.
  • Explanation of Benefits (EOB): The health insurance company provides you a notice of the bill, explaining how the charges were processed and showing you the amount you may owe to the provider.
  • Patient billing: The provider usually bills you directly for any balance of the bill not paid by the insurance company, or for any medical services not covered by your insurance. It's a good idea to compare your EOB with your bill to make sure there are no errors.