23 Jan 2015
January 23, 2015

Health Insurance Decoded

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Health Insurance Decoded

Deductibles? Co-Insurance? & Co-Pays? OH MY!!!

This month CAPTA Pediatrics would like to provide an informational newsletter about insurance deductibles, co-pay amounts and coinsurances. Most insurances start over at the 1st of the year. This means that if you have a deductible or maximum out of pocket expense, it starts over January 1. To further clarify:

  • Deductibles are part of your insurance plan that you or your employer have agreed to pay “up front” before the insurance company will begin to pay for your care. Deductibles can range from $250 per year to over $2500 per year and can vary from plan to plan.
  • Copay Amounts are a set amount of money that you will pay each time you visit your provider. This amount does not vary by the treatment that you are given. This is also agreed upon by you or your employer and your insurance company.
  • Coinsurance Amounts are a percentage you pay out of pocket for your treatment. This may or may not correspond with your maximum out of pocket expense. Coinsurance percentages usually are from 5% up to 40% of the amount authorized for reimbursement.
  • In Network vs. Out of Network means that your insurance company re-quires you to receive your healthcare from certain providers. Some insurances will allow you to receive care from an out of network provider but you may be responsible for a higher deductible, coinsurance or co-pay amount.

As a courtesy to our patients/clients, CAPTA Pediatrics ties to obtain this information for you if it is available to us. It should be stressed however, the information we obtain is just an ESTIMATE. It is your responsibility to obtain information from your insurance company. After all, it is your contract not ours.

We also wants to remind you that your insurance is a binding agreement between you and your insurance company. We as a provider have to follow your plan. We CANNOT offer discounts on your treatment, nor can we waive or write off your out of pocket amounts. If we would, we would open ourselves up to prosecution for breaking your contract with your insurance company.

Should you have any questions in regards to your benefits or coverage, our billing office will gladly try to help. You can contact them at 333-8550.