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Why Am I Being Billed A Coinsurance When I Already Paid A Copay At The Time Of My Visit?

It is imperative to know your coverage and benefits before you go to a doctor’s visit. Knowing these details of your policy is an important part of being proactive in your healthcare and understanding your medical bills.

A persons co-pay, coinsurance & deductibles are not determined by any healthcare facility you visit. Healthcare facilities also do not determine what is covered under your policy or at what rate your insurance company will pay for doctor visit. These are all determined by your insurance. Understanding how your co-pay, coinsurance and deductible work will help you know when and how much you have to pay for care.

- Deductible: A deductible is the amount you pay for health care services before your health insurance begins to pay.

- Coinsurance: Coinsurance is your share of the costs of a health care service. It's usually figured as a percentage of the amount your insurance allows to be charged for services. You start paying coinsurance after you've paid your plan's deductible.

- Copay: A copayment or co-pay is a fixed payment for a covered service, paid when an individual receives service. It must be paid before any policy benefit is payable by an insurance company.

A patient may have all three listed above within one visit depending on what you are seeing the doctor for. More than likely a co-insurance will apply for a visit after the insurance has processed the visit, even if co-pay was taken at the time of visit. The deductible will come into play if items such as X-Rays or blood work are taken.

It’s just as crucial to understand your preventive care coverage on your policy. These services are limited to once a year or even once every two years. Having these services more frequently than your policy allows can mean large out of pocket expenses for you as a patient and not having them frequently enough, can mean you are missing great opportunities for preventative care. Such wellness services that could be covered at 100%, with the deductible waived, are well child care visits, preventive screening services, immunizations, mammograms or prostate cancer screening services. To get an understanding of your insurance policy you will need to call the member services number on your insurance card.

We thank you for your continued support. Nobody takes care of you like your own.

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