Health Insurance 101-4

Deductible and Co-Payment

This is something that many people do not understand.  It should be relatively simple.  For the millionth time (big sigh here):

Deductible:

This is the amount that you have to pay “out of pocket” (they mean your money) before the insurance company is going to pay anything. 

Remember your previous lessons:

The Insurance Company has already determined what is Usual and Customary (101-1).  This may not be what the doctor charges.  Your doctor may not be a “participating provider” (101-2).  In this case he or she can charge more than what the insurance company “allows”.  And if the doctor does not participate with the insurance company, they will reimburse you (101-3).

Are you keeping up and studying? 

OK, who is responsible for paying the deductible? 

If you said the insurance holder (i.e. you) you passed the pop quiz and may progress to the next part of the course.  

You are also responsible for knowing how much it is, and how much of it you have paid.  Otherwise the office will collect either what your card says is the deductible, or the entire bill and then refund whatever they get from the insurance company.   

Co-Pay:

This is how much you have to pay every time you have an “encounter”.  It may be:

·        A percentage of the charge

·        A percentage of the usual and customary

·        A fixed amount

·        The difference between the percentage of usual and customary that your insurance company is going to pay and the total charge (if the doctor does not participate)

You must pay your deductible first.