Medical Claims 101: How Your Bill Gets Paid

Understanding how your medical bill gets paid can help you feel more confident and in control of your healthcare finances. While the process may seem complex, it follows a fairly standard path—from your doctor’s office visit to your final payment. Medical Claims 101 breaks it down into clear, simple steps so you can better understand what happens behind the scenes after your appointment and how your insurance helps cover the cost.

1. You visit your doctor. Copays may be due at time of service. 
2. Your doctor sends your claim to your Insurance Company.
3. The Insurance Company sends you an Explanation of Benefits (EOB).
4. The Insurance Company pays your doctor.
5. Your doctor sends you a bill for the remaining balance.
6. You pay your doctor.