Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider.

After a medical claim is submitted, the insurance company determines their financial responsibility for the payment to the provider. This process is referred to as claims adjudication. The insurance company can decide to pay the claim in full, deny the claim, or to reduce the amount paid to the provider.

The medical billing insurance claims process starts when a healthcare provider treats a patient and sends a bill of services provided to a designated payer, which is usually a health insurance company.

When you switch from your insurer to a new insurer, you get to retain the waiting period benefits. Simply put, you do not need to bear the waiting periods all over again. This feature is better known as insurance portability. So if you are looking to take a leap, you better take it.

Yes, you can get a health cover even if you already have a pre-existing condition. But the catch to it is that you’ll have to bear a waiting period (which is usually four years) before the plan starts covering your pre-existing condition. For the first four years, the plan continues to give you a health cover excluding the pre-existing conditions and the related complications arising thereof.

Insurance coverage is the amount of risk or liability that is covered for an individual or entity by way of insurance services.

A deductible is the initial amount you must pay each year for covered health services before your insurer will start to chip in. Pl  may have separate individual and family deductibles and/or deductibles for separate services such as hospitalization. A copayment is a fixed amount you pay toward each medical service, such as AED 25 for a checkup.

An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. An out of network simply me  that the doctor or facility providing your care does not have a contract with your health insurance company.

Direct billing occurs when doctors or medical providers send their bills straight to the health insurance company for payment, rather than having the patient receive the bill and file the claim. It is applicable only at clinics/hospitals/pharmacies mentioned in the networks list provided by the insurer.

The area within which the insurance is applicable.