Continuing the round of "definitional" posts to get this blog started ... it's time to talk copays.
Copays are fees that you are required to pay each time you have a particular service under your health insurance. These fees take the form of a flat dollar amount that you pay each time you have a particular service - for example, $15 per office visit or $50 per emergency room visit.
Showing posts with label choosing an insurance plan. Show all posts
Showing posts with label choosing an insurance plan. Show all posts
Monday, December 5, 2011
Wednesday, November 16, 2011
What is a Deductible?
So, the first round of posts at this place will be a few definitions of common insurance and medical billing terms that are helpful for people to understand when trying to decipher mounds of insurance paperwork. Once we've established the key terms that you might hear while you're trying to navigate your medical billing and insurance issues, we can start talking about what you should do if you encounter a range of common problems.
Okay, so first off: What is a Deductible?
The term "deductible" refers to the amount of money that a patient (or family) is required to pay toward their medical expenses before their insurance company will begin making payments on claims filed on their behalf.
In other words, once you begin coverage with an insurance policy, they will immediately process all claims sent to them on your behalf. However, they will not make payment on any of your claims until they have received $1000 (or however much your deductible is) in charges from various doctors. So your doctor's office will send the claims to your insurance like normal, but you will ultimately be billed by your doctor for the full amount of the bill* and you will be fully responsible for payment. Once you have been billed for the first $1000 (or whatever your deductible is) of treatment, your insurance will begin to actually make payments on your behalf to your doctors' office.
Deductibles reset every policy year (so you should make careful note of the start date of your policy), so that you will have to pay the first portion of your medical charges out of pocket every single year you are on the policy.
Deductibles also apply to patients, not to a specific doctor. So you will not have to pay a separate deductible to each doctor's office - just one per patient per policy year.
You will probably have two separate deductibles listed on your policy - one for in-network doctors, and a higher one for out-of-network doctors. We'll talk more about the distinction between them in the future. For the time being, though, try to see only in-network doctors whenever possible.
It's worth noting that some policies will have exceptions to the deductible listed in the contract - they will agree to pay for two office visits before the deductible kicks in, for example ... or not apply the deductible to preventative care services or prescriptions or something similar. If you have a policy like that, make sure that you pay careful attention to what services are exempt from the deductible, and make sure your insurance company processes those bills correctly.
Okay, so first off: What is a Deductible?
The term "deductible" refers to the amount of money that a patient (or family) is required to pay toward their medical expenses before their insurance company will begin making payments on claims filed on their behalf.
In other words, once you begin coverage with an insurance policy, they will immediately process all claims sent to them on your behalf. However, they will not make payment on any of your claims until they have received $1000 (or however much your deductible is) in charges from various doctors. So your doctor's office will send the claims to your insurance like normal, but you will ultimately be billed by your doctor for the full amount of the bill* and you will be fully responsible for payment. Once you have been billed for the first $1000 (or whatever your deductible is) of treatment, your insurance will begin to actually make payments on your behalf to your doctors' office.
Deductibles reset every policy year (so you should make careful note of the start date of your policy), so that you will have to pay the first portion of your medical charges out of pocket every single year you are on the policy.
Deductibles also apply to patients, not to a specific doctor. So you will not have to pay a separate deductible to each doctor's office - just one per patient per policy year.
You will probably have two separate deductibles listed on your policy - one for in-network doctors, and a higher one for out-of-network doctors. We'll talk more about the distinction between them in the future. For the time being, though, try to see only in-network doctors whenever possible.
It's worth noting that some policies will have exceptions to the deductible listed in the contract - they will agree to pay for two office visits before the deductible kicks in, for example ... or not apply the deductible to preventative care services or prescriptions or something similar. If you have a policy like that, make sure that you pay careful attention to what services are exempt from the deductible, and make sure your insurance company processes those bills correctly.
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