One key to understanding and utilizing your health insurance is to understand the health insurance terms that explain your policy. These terms can be confusing to many different people, and can cause payment issues when you use your insurance. It is important to understand your health insurance policy completely, so that you understand what you are responsible for paying.
Deductible
The deductible on your insurance policy is the amount you must pay before the insurance will begin picking up the bill. Some insurance companies do not count doctor’s visits towards the deductible, and you will just need to make your copayment at your doctor’s office. The deductible will be met when you have a test or procedure done or you visit the hospital.
Copayment
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The copayment is the amount you pay to the doctor or hospital whenever you have a visit. The amount should be listed on your insurance card. You will need to make the payment each time you visit the doctor. Copayments do not count towards your maximum insurance amount or your deductible amount.
Coinsurance
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The coinsurance is the amount that you must pay after the health insurance has picked up a portion of your payment. This is usually listed on your policy as 80/20 or 70/30, for example. You will be responsible for the second number listed as a percentage, so twenty or thirty percent of the bill from the hospital.
In-Network and Out-of-Network
In-network and out-of-network refer to whether or not the doctor or hospital has made an agreement with the insurance company to reduce payment amounts for their customers. The insurance company may require you to pay higher co-payments and coinsurance if you choose to visit doctors who are not in their network of approved doctors.
When you read your hospital bills and insurance statements you should see that the insurance reduces the amount of the bill, because of agreements between the hospital and insurance company. You should always wait for your insurance statements to go through before paying the coinsurance on a bill. If you pay too much, you can request a refund from the hospital or doctor, but it can take some time to process.
Understanding health insurance terms will make it easier to use your insurance. It allows you to determine how much to pay, when to pay it and to make sure you are being billed the correct amount. It makes dealing with the billing process much easier.
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