Here are some plain language definitions that your insurance uses to explain the money that you, the patient, may owe for your healthcare. Please call our billing office at (877) 673-0903 if you have any questions about what you may owe or if you need some help in understanding what you owe.
Your insurance plan says you must pay this amount for your visit, no matter what the insurance will pay eventually, or how much the visit costs.
Example: A $20 co‐pay for office visits, a $50 co‐pay for emergency room visits
You are responsible for this portion until it has been met on an annual basis. This is in addition to your visit co‐pay. Once your deductible has been met, bigger benefits from your insurance will apply.
- A $1000 deductible means that you must pay the first $1000 of the expenses that your insurance covers
- This is in addition to your co‐pay for each visit
This is the total amount annually that you would pay for covered medical expenses. After you’ve met your out‐of‐pocket
expenses, your insurance may pay 100% of your expenses
- This helps for catastrophic events like long term illness, cancer treatments, devastating accidents
- If you have an out‐of‐pocket total of $5000, then once you have personally paid $5000 that year (which usually includes your deductible), your insurance kicks in at 100%
Your insurance may have a contract with your clinic, doctor or hospital. They have agreed to adjust off a certain amount of what they charge. This is an advantage to you as the patient because even if you have a high deductible or out‐of‐pocket expense, you may not have to pay the original charges. This contractual adjustment does not include your co‐pay. You still have to pay this for each visit.
Example: The clinic charges $200 for your visit. Your co‐pay is $20. The insurance has negotiated a 20% discount with your clinic. This means that the clinic makes an adjustment of $40, leaving a balance of $160. You pay your $20 co‐pay for the visit, plus $160 dollars if you have not met your deductible. This gives you a total discount of $20 off your visit. Instead of paying the full $200, you paid $160 + $20 co‐pay = $180.