A Coinsurance is the amount you pay to share the cost of covered services after your deductible has been paid. The coinsurance rate is usually a percentage. For example, if the insurance company pays 80% of the claim, you pay 20%.
A Copayment is one of the ways you share in your medical costs. You pay a flat fee for certain medical expenses (e.g., $10 for every visit to the doctor), while your insurance company pays the rest.
A Deductible is the amount of money you must pay each year to cover eligible medical expenses before your insurance policy starts paying.
An Out-of-pocket Maximum is the most money you will pay during a year for coverage. It includes deductibles, copayments, and coinsurance, but is in addition to your regular premiums. Beyond this amount, the insurance company will pay all expenses for the remainder of the year.
An Explanation of Benefits is often mistaken for as a bill from the insurance company. It is actually the health insurance company’s written explanation of how a medical claim was paid. It contains detailed information about what the company paid and what portion of the costs you are responsible for.
Our physicians are specialists, and most insurance providers require a higher co-pay for a specialist visit.