00 for a surgical procedure. The manager comes by and specifically tells the medical biller that the $3,000 claim has to go first because that's too much money to sit on. So the poor worker does what he is told and submits the $3,000 claim while the $100 claim sits in the drawer.

The person who just had the $3,000 operation is paid promptly, provided that the claim itsel

As a patient, we want to believe that our lives are in the hands of people who we can trust to do their job of medical billing without looking at the bottom line. But the sad truth is, it's the size of the claim and not the seriousness of your problem that gets the highest priority when it comes to crunch time.

The biggest problem with medical billing is that it's still a business. The medical billing agencies get their money from getting a premium paid on each claim based on how much the claim itself is. If you're doing bulk business, this really ads up over time. The doctors are willing to pay for this service because they just don't have the time to do the billing themselves. So that's where the big companies come in.

The problem arises when the company gets backed up. How does this happen? Simple. As claims get submitted, a certain percentage of them are going to get denied. There is no way around this. Medical billing personnel make mistakes and claims get fouled up. Well, when this happens, these claims have to get resubmitted. While these claims are being resubmitted, new claims are coming in. Eventually, over time, a backlog starts to form. With that happens, the following situation is what the medical biller is faced with.

In front of this person sits two claims. The backlog is already up to a week if not longer. The old claim that has to be resubmitted is for a paltry $100 for an office visit. Sitting right next to this claim is a brand new claim for $3,000 for a surgical procedure. The manager comes by and specifically tells the medical biller that the $3,000 claim has to go first because that's too much money to sit on. So the poor worker does what he is told and submits the $3,000 claim while the $100 claim sits in the drawer.

The person who just had the $3,000 operation is paid promptly, provided that the claim itsel

business. The medical billing agencies get their money from getting a premium paid on each claim based on how much the claim itself is. If you're doing bulk business, this really ads up over time. The doctors are willing to pay for this service because they just don't have the time to do the billing themselves. So that's where the big companies come in.

The problem arises when the company gets backed up. How does this happen? Simple. As claims get submitted, a certain percentage of them are going to get denied. There is no way around this. Medical billing personnel make mistakes and claims get fouled up. Well, when this happens, these claims have to get resubmitted. While these claims are being resubmitted, new claims are coming in. Eventually, over time, a backlog starts to form. With that happens, the following situation is what the medical biller is faced with.

In front of this person sits two claims. The backlog is already up to a week if not longer. The old claim that has to be resubmitted is for a paltry $100 for an office visit. Sitting right next to this claim is a brand new claim for $3,000 for a surgical procedure. The manager comes by and specifically tells the medical biller that the $3,000 claim has to go first because that's too much money to sit on. So the poor worker does what he is told and submits the $3,000 claim while the $100 claim sits in the drawer.

The person who just had the $3,000 operation is paid promptly, provided that the claim itsel

ises when the company gets backed up. How does this happen? Simple. As claims get submitted, a certain percentage of them are going to get denied. There is no way around this. Medical billing personnel make mistakes and claims get fouled up. Well, when this happens, these claims have to get resubmitted. While these claims are being resubmitted, new claims are coming in. Eventually, over time, a backlog starts to form. With that happens, the following situation is what the medical biller is faced with.

In front of this person sits two claims. The backlog is already up to a week if not longer. The old claim that has to be resubmitted is for a paltry $100 for an office visit. Sitting right next to this claim is a brand new claim for $3,000 for a surgical procedure. The manager comes by and specifically tells the medical biller that the $3,000 claim has to go first because that's too much money to sit on. So the poor worker does what he is told and submits the $3,000 claim while the $100 claim sits in the drawer.

The person who just had the $3,000 operation is paid promptly, provided that the claim itsel

Eventually, over time, a backlog starts to form. With that happens, the following situation is what the medical biller is faced with.

In front of this person sits two claims. The backlog is already up to a week if not longer. The old claim that has to be resubmitted is for a paltry $100 for an office visit. Sitting right next to this claim is a brand new claim for $3,000 for a surgical procedure. The manager comes by and specifically tells the medical biller that the $3,000 claim has to go first because that's too much money to sit on. So the poor worker does what he is told and submits the $3,000 claim while the $100 claim sits in the drawer.

The person who just had the $3,000 operation is paid promptly, provided that the claim itsel

00 for a surgical procedure. The manager comes by and specifically tells the medical biller that the $3,000 claim has to go first because that's too much money to sit on. So the poor worker does what he is told and submits the $3,000 claim while the $100 claim sits in the drawer.

The person who just had the $3,000 operation is paid promptly, provided that the claim itself was submitted properly. The claim will probably be paid within 30 days. In the meantime, the $100 claim that was denied is already at least 30 days old if not older, since the insurance carrier takes its sweet time in even getting to these once they are submitted. So now, it's over 30 days, maybe even 60 and this claim is still sitting in a drawer. So the poor patient who can really use the $100 is still sitting at home waiting for his check, as most doctor visits have to be paid up front.

Is this common? It is very common. Most people won't admit to it but this goes on all the time. Is it right? Well, it isn't the purpose of this article to judge. We're just stating the facts of what goes on behind the scenes. Certainly, you can understand the point of view of the company who is trying to make a living and pay its employees. You can also understand the poor patient's complaints about just wanting to get his office visit paid for.