Insurance FAQ’s

What charges am I responsible for when I go to the doctor?

Depending on your health plan, you may have:

  • A copay at each visit
  • An annual deductible (and possibly a family deductible)
  • Coinsurance (the percentage of the doctor’s bill that you pay after you meet your deductible)
  • Charges for non-covered services or charges in excess of the allowed amount (if you go to a non-network doctor or facility)

 

Co-payments:  What are they and why do I have to pay?

A copay is a fixed amount you pay for a health care service (like an office visit), usually when you receive the service. The amount can vary by the type of service.

How it works: Your plan determines what your copay is for different types of services. Your copay is due at every visit even when you have met your deductible.

-Patients have a contract with their covering health insurance company that they will be responsible for certain parts of their health-care. .

– Doctors also have a contract with participating insurance companies. It is not optional for us whether or not to collect a copay. We are obligated out of contractual obligations. If we fail to carry out our duties outlined in our contracts, the insurance companies can drop us as participating providers.

 

Deductible:

A deductible is the amount you pay for health care services before your health insurance begins to pay.

How it works: If your plan’s deductible is $1,500, you’ll pay 100 percent of eligible health care expenses until the bills total $1,500. After that, you share the cost with your plan by paying coinsurance.

 

Co-insurance:

Coinsurance is your share of the costs of a health care service. It’s usually figured as a percentage of the amount we allow to be charged for services. You start paying coinsurance after you’ve paid your plan’s deductible.

How it works: You’ve paid $1,500 in health care expenses and met your deductible. When you go to the doctor, instead of paying all costs, you and your plan share the cost. For example, your plan pays 80 percent. The 20 percent you pay is your coinsurance.