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Insurance Terminology Got You Down?

Trying to understand all the different terms?  Let us try to help you out with a few of the common terms we use in the office.

Co-pay. This is an amount ranging anywhere from $5.00 to $60.00 per visit (yes, each visit) that the insurance company has you pay towards your care.  The insurance company will deduct from the allowable amount of the service the amount of your co-pay and that is what we are paid.  For example:  We bill the insurance company $70.00 for an office evaluation and your co-pay is $30.00, the insurance company allows $60.00 for the visit, they will pay us $30.00 for this service considering you paid the $30.00 difference in your co-pay.  Co-pays can be for visits, procedures and x-rays.  This will all depend on your individual coverage.  This year we are finding you can have multiple co-pays per visit, such as, a visit co-pay and an x-ray co-pay.

Deductible. This can be any dollar amount determined by the insurance company.  The insurance company will apply the deductible to your services using the allowable/approved amounts and pay us nothing until you have satisfied your deductible amount.  We do check prior to your visit what your deductible responsibility is and how much has been applied to date.  Most insurance companies allow deductibles towards procedures including nail care and injections, as well, x-rays.  If you have a co-pay for your visit, the deductible will most likely not apply to the visit but each individual insurance company has their own set of rules and we have seen a visit have a co-pay and deductible charged to it.

Co-insurance. This is a percentage amount determined by the insurance company for you to pay towards your services.  The most common are 80/20 or 90/10.  The insurance company will apply this percentage amount to all your services and from the allowable will pay us 80% leaving 20% of the fee for you to pay. 

Co-pays, deductibles and co-insurance are due at the time of services rendered.  We do have approved amounts from the different insurance companies and can inform you of your responsibility for the care you received.  We understand insurance is difficult and you are given an overwhelming amount of paperwork when you receive it.  We try our best to give you the most up to date information we have to help you understand your responsibilities.  It seems as we all are paying more and more for our care.  Please understand that the co-pay, deductible and co-insurance amounts are set by the insurance coverage that was chosen for you by either you or your employer.

It is our office policy to collect the amount at the time of service just like you would pay for all other services when you receive them.  We all have the same health insurance issues and concerns as we all deal with coverage personally and appreciate your attention to this very important matter.

Posted in Insurance
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