If your claim was submitted to your health insurance provider, the balance you see on your medical bill could be comprised of your insurance deductible, coinsurance payment, and/or copay payment.
What is the insurance deductible?
- The insurance deductible is the amount you pay out-of-pocket for healthcare services and treatment before your insurance carrier begins to pay.
- All of your deductible must be met before your insurance carrier starts to share the covered cost(s) with you.
- Example: You have an annual plan deductible of $2,500.00. You pay all eligible health expenses until the bills total $2,500.00. After the deductible has been met, you will then start to pay coinsurance.
What is coinsurance?
- Coinsurance is your share of the cost(s) for covered health services and treatment usually figured as a percentage.
- You will start to pay coinsurance after your plan deductible has been met.
- Example: You have met your $2,500.00 deductible for a calendar year. Your plan pays 80% of covered expenses and your share of the cost is 20% - the 20% share that you owe is coinsurance.
What is a copay?
- A copay is a fixed and predetermined dollar amount you pay for certain types of services or visits covered by your insurance plan. The amount of the copay you are responsible for paying varies depending on the type of provider you are seeing and it is set by the health insurance carrier.
- Copays are independent of deductible contributions.
- Example: You pay a $40.00 copay when you visit your family doctor but are responsible for an $80.00 copay when you visit a dermatologist because the dermatologist is a specialist.
Consult your insurance benefits package for more information on the type of coverage you are eligible to receive for different treatments and services. An insurance representative or a hospital billing specialist can also discuss each line of your medical bill and explain why an item was or wasn’t covered.
If the Explanation of Benefits (EOB) provided by your health insurer shows the total of your medical bill should be less than it is, provide a copy of the EOB to the health care provider’s billing department so the balance can be adjusted.
If you find that services and/or treatment was not covered because you were cared for by an out-of-network physician, ask your insurance provider how to submit an out-of-network claim.
If you have other questions about planning for health care expenses, dealing with medical bills, or understanding how health insurance works, you’re invited to schedule a free, confidential 20-minute call with Kelsey Shaner, a OneMain Trim team member who is also a Board Certified Patient Advocate. Appointments are subject to availability, first-come, first-served.
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