Billing & InsuranceWe are here to help with your insurance questions.

Understand Your Insurance Coverage

Important terms

Admitting Privileges
The right granted to a doctor to admit patients to a particular hospital.

Advocacy
Any activity done to help a person or group to get something the person or group needs or wants.

Agent
Licensed salesperson that represents one or more health insurance companies and offers their products to consumers.

Benefit
Amount payable.

Co-Insurance
The percentage of covered expenses you share with your insurance company.

Co-pay or Co-payment
The dollar amount you must pay toward the cost of a benefit. Usually paid at your doctor’s office visit.

Deductible
The dollar amount of eligible expenses you must pay during each policy year before benefits are payable by the insurance company.

Understand Your Insurance Coverage

Health insurance is complicated. Understanding the details of your own health insurance coverage will help to maximize your coverage and minimize your out-of-pocket costs.


Difference Between Co-Insurance and Deductible

If your health insurance company says a covered benefit “applies to deductible and co-insurance,” you must pay the amount of your deductible. Your deductible is a declining balance. You must pay the amount of your deductible before your insurance company begins to reimburse you for medical expenses.

After you have paid your deductible, then you only need to pay co-insurance, or a portion of your medical expenses. Your health insurance company pays the rest. Under most health insurance plans, there is a limit to the amount of co-insurance you have to pay. This is known as an “out-of-pocket maximum.” In general, you pay your deductible and co-insurance directly to the doctor’s office, not to the insurance company.


Co-Pays or Co-Payments

You pay a co-pay (or co-payment) at the doctor’s office. A co-payment is a fixed amount of money that you pay when the doctor delivers (or renders) services to you. Co-pays DO NOT count toward your deductible or co-insurance. Depending on your insurance policy and on the kind of doctor you see, the amount of your co-pay may not always be the same. For example, you might pay a $20 co-pay to see a Family Practitioner, but you might pay a $50 co-pay to see a specialist, such as an Oncologist. In general, if the doctor’s title has “ist” at the end, the doctor is a specialist and not a primary care doctor.


Important Notice

Beginning January 2, 2014, please show your insurance card, drivers license and pay your co-pay before seeing the physician or before treatment begins.

If your insurance has changed, please advise the receptionist or our medical assistant when arriving for your appointment.

Do you have additional questions?