Avoid Surprises by Getting to Know These Insurance Terms

Understand your Benefits!

A new year could possibly bring new insurance or changes to your coverage. No one wants to be shocked when going to the doctor’s office for the first time in a new year. 

We are here to help! Today we want to break down some common insurance terms so you can know what to look for. We will also walk you through a couple of scenarios that will show you what you can expect to pay for a visit given your coverage.

When scheduling an appointment with Neuhaus Foot & Ankle, please provide your insurance information. We will be able to verify your benefits and estimate any cost you might have to cover. When you check in, we’ll then be able to explain this information to you before seeing the doctor.

Now let’s break down some insurance terms so you can know what to expect on your next trip in!

 

Common insurance terms

 

What is the difference between Co-Insurance and Deductibles?

These are terms that are often confused with one another. Let’s break it down in simple terms. Your Deductible is a declining balance that must be paid in full before your insurance company will pay for covered medical expenses.

When your deductible is reached, you will then only have to pay Co-Insurance. Co-Insurance is a portion of your medical expenses that you are responsible for.  Your health insurance will cover the rest. Most health insurance plans have a limit to the amount of co-insurance you will have to pay. This is called an “out-of-pocket maximum

You pay your Co-Pay/Co-Payment at the doctor’s office. This is a fixed amount that you are responsible for when the doctor serves you. Co-Pays do not count toward your deductible or co-insurance. Co-Pays also vary depending on the doctor you are seeing. For instance, depending on your insurance, you might pay a $20 co-pay to see your family practioner, but you might pay a $50 co-pay to see a specialist. 

 

Example of In-Network Claim (Deductible Not Met)

At the beginning of each year, deductibles reset. So your first few doctor’s visits could cost you a bit more out of pocket. Remember, your deductible must be paid before your insurance company will pay for medical expenses. Below is an example of an in-network claim where your deductible has not yet been met. Dollar amounts below are examples and will vary depending on your services and health insurance.

Source: https://healthypack.dasa.ncsu.edu/insurance-and-billing/insurance-101/

In this example, your co-pay for this visit is $20 and is deducted first: $250-$20=$230. After that your deductible applies. $230-$200=$30. Next your co-insurance applies; here you are responsible for 20% of $30, or $6. Your insurance is responsible for the other 80% of $30, or $24. Your total responsibility for this trip is $226.

 

Example of In-Network Claim (Deductible Met)

After your deductible is met, your out-of-pocket expenses decrease. Below is an example of how your claim might break down after meeting your deductible. Dollar amounts below are examples and will vary depending on your services and health insurance.


Source: https://healthypack.dasa.ncsu.edu/insurance-and-billing/insurance-101/


In this example, your co-pay is $20 and is deducted first: $250-$20=$230. Because your deductible is met for the year, we jump to co-insurance. You are responsible for 20% after your co-pay, 20% of $230, or $46. Your insurance company is then responsible for the remaining 80% of $230, or $184. Your total responsibility for this trip is $66.

 

If you'd like more information explaining health insurance, check out this video!

If you are ready to start of your year on the right foot, contact us to schedule an appointment at any of our Middle Tennessee locations. We have experienced podiatrists in Nashville, Brentwood, Lebanon, Mt. Juliet, Gallatin, Hermitage, Smyrna, and Waverly that accepting new patients!

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