The Importance of Cents in the Healthcare Payment System

mgbrousse
Apr 29
3 min read

By Martine G. Brousse (not AI!)

"The Medical Bill Whisperer"™

Patient Advocate, Certified Mediator

AdvimedPro

April 29, 2025

There have been a lot of discussions over time about whether the penny and other coins should just be discontinued. Well, that discussion does not really apply here as Cents are essential to the healthcare payment system. Why? Let ‘s explore.

A. Why are Cents important?

1. Healthcare is part of the Monetary System

· Healthcare payment transactions are done electronically. Think credit card receipts, direct deposits of your paycheck, electronic fund transfers to pay your bills. All of these transactions MUST include cents. That is the same thing for the healthcare payment system.

· If a charge has no cents, the system will move the decimal point back 2 numbers, NOT add .00

2. The Out of Network (“OON”) issue

· Reimbursements sometimes are affected by the lack of cents on OON invoices. You get services from an out of network provider, who has no legal requirement to bill your insurance. Instead, you receive an invoice, claim form or superbill to submit to your insurance for reimbursement.

· Why are you stuck with doing that billing job? OON providers have no liability or responsibility to submit their charges directly to your insurance. They have no financial incentive as you pay them directly, and are often individuals or small offices with no staff or training to bill insurances.

· The insurance claim system will automatically assign cents to a charge. But that does not mean adding two zeros. It means shifting the decimal point back so a $450 charge will be processed as $4.50 not $450.00.

· You pay full price to the provider, and you are getting an invoice worth 100 times less. See the problem?

B. Solutions

1. Check first, then submit

· Always check OON invoices or superbills for cents, as well as other necessary info, codes or data that insurance payment systems require to process and pay claims.

2. Insist on valid / proper documentation

· If cents are not there, insist that the office or provider issue a valid invoice, claim form or superbill.

· Once they do, submit it for reimbursement as usual: through your online portal, fax, snail mail, etc,

3. If denied or incorrectly processed

· If you already submitted a charge without cents, and it was processed with a shift of the decimal point, all is not lost.

· Ask the provider or office to correct or update that document. Some smaller offices may use a system that cannot be adapted to add cents, or they may not know how to do so.

· If the provider cannot correct the document themselves, you might be able to do it yourself, but you must get the okay from that provider before amending any invoice or super bill. Changing invoices without written approval from the entity that issued it, is not a legally acceptable and accepted practice.

· Once an updated super bill or claim form is available, do not resubmit as a new claim, it will result in a denial as a "duplicate".

· Instead, submit it as a corrected invoice along with a copy of that EOB through the portal, fax or snail mail. Both the EOB and the updated invoice MUST show the term “corrected billed amount” on them.

· Follow up to make sure there's no duplicate rejection. If there is, ask the insurance phone rep to send that corrected or updated invoice back for reprocessing. You can also send the request through the online message system. If that fails, an appeal might be in order. It is your right to request that that charge be reprocessed based on the new info or on an updated field, even if some time, effort and patience will be needed.

Although it is unfair that you be forced to submit OON claims yourself, unfair that invoices you receive may not be valid or complete, unfair that your insurance’s demands and programing comfort come ahead of your rights and needs, the current healthcare landscape is such that patients, way too often, have to fight to get their own money back.

Preparation – checking invoices in this case - is always good advice, as is follow up and getting the office/provider to do that they must, as well as correctly as possible.

Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances.