In what situation would a patient receive a bill after their insurance has processed a claim?

A patient may receive a bill after their insurance has processed a claim when deductibles are not met. A deductible is the amount that a patient must pay out-of-pocket for healthcare services before their health insurance begins to cover the costs. If a deductible has not been fully paid, the insurance will process the claim but will not cover the costs until the deductible requirement is satisfied. This means that the patient will be responsible for paying the remaining amount that corresponds to the unmet deductible.

In the case of denied claims or incorrect processing, the situation typically means the patient won't face a bill related to those specific services, as no payment will be made at all. When coverage limits are reached, patients may not be billed for services within their limits. When a claim is processed incorrectly, this may lead to disputes or adjustments rather than immediate billing to the patient.