January 15, 2023
As we are in the first few weeks of the new year in the healthcare world, that means for most it’s the time when your deductible starts over at either a current or higher amount. It is a good time to review details of your medical insurance plan and update any current providers you may be seeing. All of those details can be confusing and overwhelming. We’ve listed some common terms and definitions below to help you be an informed consumer in the healthcare arena.
The amount you owe for health care services before your insurance or plan begins to pay. For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1000 deductible. Your deductible may not apply to all services.
A fixed amount (example, $15) you pay for a covered health care service, at the time of service. The amount may vary based on the covered health care service.
Your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service. This often applies after your deductible has been met. For example, if your plan’s allowed amount for a visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.
Maximum amount on which payment is based for covered health care services. Can also be called “eligible expense” or “negotiated rate.”
The above items make up your patient responsibility portion of your health plan and are due to whichever medical provider you see first in the calendar year. Please note that all medical providers are contractually obligated to collect your patient responsibility portion, which may include deductibles, co-insurances, and co-payments.
Legislation was passed that makes it a law for all healthcare facilities to be transparent (up front and visible) about their charges of care. www.wipricepoint.org is a site that provides average hospital charges. At New Life Physical Therapy, our charges are published and available for your review. We can also provide an estimate of what your insurance allowed amount may be*. In addition, we offer time of service self-pay discounts, which are helpful for those without insurance, high deductibles or out of network plans.
Our goal is to put you on a path to succeed in doing life’s important things. That includes keeping you informed on costs for your plan of care and answering any related questions.
Questions? Contact our Insurance Specialist email@example.com