It can be confusing but here are a couple of key terms to know and understand.
Deductible: Simply put, the dollar amount the patient is responsible for paying before insurance will pay.
Co-Payment: The flat fee determined by insurance the patient owes per visit before leaving the doctor office.
Co-Insurance: This is the percentage you and your insurance agree to pay respectfully. If the plan covers at 90%, the patient responsibility would be 10% of the final adjusted amount. (The deductible and co-payment may still apply).
Out of pocket benefits: When this dollar amount is met, and your deductible has also been met, insurance will usually pay at 100%. Even if your co-insurance is 90%, your insurance should cover at 100% once the out of pocket has been met.
In and/or Out of network benefits: Some medical insurances offer both in and out of network benefits. The out of network benefits may run higher than the in-network, but if you already have a high deductible where you carry the responsibility, using out of network benefits become a mute point. Out of network benefits do help in the case where you may need a provider in a pinch or worse, in an emergency, your insurance may cover some of the costs of that doctor visit or procedure.
These are some “layman’s” explanations for the common insurance terms we run into on a daily basis. All patients need to consult their insurance carrier directly to know their exact benefits.
We at Lincoln Square Chiropractic and Physical Therapy are currently in network with the following: Blue Cross Blue Shield PPO, Blue Choice PPO, United Healthcare PPO, Aetna PPO and some Cigna PPO. (This list is subject to change).