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Understanding Your Benefits

The healthcare industry is constantly evolving. Understanding health insurance benefits can be hard. What plan should you choose? What coverage do you need? We are here to help. Here are some basic explanations of the different types of coverages commonly offered:

Copay Plans: Copays are a set dollar amount that the patient pays for each visit. Copays can range anywhere from $10 to $75 depending on your plan. Some plans subject patients to both copays and deductibles. If you have this type of plan, the copay is collected at the time of service and the deductible amount will be billed to you.

Deductible Plans: Deductibles are the amount of money a patient has to pay out of pocket before the insurance will cover office visits and procedures. Deductibles can range anywhere from $100 to even $12,000! After the deductible is met, the insurance will typically pay 50% to 100%. If you have this type of plan, the allowed/contracted amount is collected at time of service is based on your visit. The amount collected typically ranges from $35 to $116.

Coinsurance: Coinsurance is the patient responsibility after the deductible is met. After the deductible is met, the insurance will typically pay 50% to 100%. So, the coinsurance can range anywhere from 0% to 50%.

Remember, each insurance company is different. Each plan offered within these companies can also offer different benefits. It is always best to know your insurance benefits prior to your appointment. Please contact our office with any questions you have regarding your plan benefits.