Insurance World can be confusing! Deductible? Out of pocket Costs? HSA account? Omg! Overwhelming! But I am here to help you 🙂
Although there are slight differences between services that your insurance covers,the general idea is the same.
Currently, I work for a doctor’s office as a Lead Medical Clerk. I deal with Insurance Q&A on daily basis 🙂
Lets first look at what a deductible is. My husband used a car insurance example to explain this to my mother in law.
-When you buy Ins coverage for your car,you can select a deductible amount-what is your responsibility is (cash) that you would pay before the insurance covers the rest.The same principle applies to medical insurance. When you have a deductible with your medical plan that just means that you need to pay a specific amount of money before insurance company starts covering your services at 80% INS/20%PT, 70%INS/30%PT or 90%INS/10%PT.
This brings me to the next topic:coinsurance (examples above). Coinsurance is the amount you are responsible for, after you satisfy your deductible. You pay this amount until you meet your out of pocket costs
Out of pocket Costs is the amount of money you have to pay,for services rendered a year. After this set amount is met the insurance company covers you @100%. ! Yay 🙂 Unfortunately, OOP costs could be high and it could take you a while to pay them….
Fortunately, some people might have a thing called HSA account to help them with the high OOP costs or high deductible. This is offered by your employer -a certain amount of $ goes towards medical expenses, medications or any other medical related expenses that your plan doesn’t cover. Just make sure to let your provider know that you have a HSA account and that way you can use the HSA debit card or the money can be taken out of the account. This prevents any future billing issues. ! 🙂
Ok, I hope you guys feel more comfortable with this topic.
Till next time, Kate
KR2 Medical Billing 