Billing and Benefits

Understanding Your Co-Payments and Deductibles

We understand that medical bills and insurance terms can be very confusing. For this reason, we are providing the following information. Many patients believe that because they have insurance, they will not have to pay out of pocket for any part of their medical care. However, the amount you are required to pay for your medical care depends on your insurance policy. The portion you are obligated to pay (also referred to as the patient responsibility) may be in the form of a copayment, coinsurance, or a deductible. Briefly, a copayment is a fixed dollar amount that may be indicated on your insurance card. Copayments are generally not very large, may vary according to the type of doctor or facility you utilize, and are always due at the time of your appointment. A coinsurance is similar to a copayment but it is not a fixed amount. Instead a coinsurance is calculated according to your insurance policy as a percentage of the cost of your medical care. For example, all Medicare patients have a 20% coinsurance. This means that for every $100 of your medical bill, you are responsible for paying $20. Some patients purchase a supplemental insurance to cover this 20% coinsurance. Lastly, a deductible is the amount that you must pay before your insurance will begin to cover your medical expenses. Nowadays it is not uncommon for patients to have deductibles of $1000 or more. In this example, the patient must pay for his/her first $1000 of medical care before his/her insurance will take effect. You can find out what your copayments, coinsurances and deductibles are by calling your insurance company. Because we accept your insurance, we are required to collect your copayments, coinsurances, and deductibles. Your insurance company will not pay any part of your bill for which you are responsible. As one of your health care providers, we kindly ask our patients to take care of their patient responsibilities promptly. If you have any questions regarding your account balance or you would like to work out a payment plan, please contact our business office at (302) 629-3526.