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UNDERSTANDING HEALTH INSURANCE: PATIENT COST SHARE

I find that one of the biggest issues for my practice is patient cost share.Patient cost share is the amount of money that you, the patient, has to apply to his or her insurance reimbursement.


There are three main types: deductible, copay and coinsurance. Most patients will have one or a combination of these type of cost shares. The first is a deductible, which requires the patient to pay out of pocket the entire allowed amount of his or her insurance fee schedule, until a set monetary threshold is met. The second is a copay which requires the patient to pay a per visit rate that is taken directly out of the allowable payment for the services provided. The third is a coinsurance, in which the insurance will take a percentage of the allowable amount and make it the patient’s responsibility.


All of these cost share scenarios are confusing. We recommend that all patients contact their respective insurance providers and ask questions. Be specific about the type of treatment you are receiving and in what setting the insurance will be billed. We also recommend that you pay attention to your health care billing. Be sure to always review your Explanation of Benefits (EOB’s), along with the bills, and don’t be afraid to contact your provider or insurance carrier with any questions.


Unfortunately, as both patient and provider know, cost share is common and is probably here to stay. Be informed and know your insurance so there aren’t any surprises. If you do receive a bill or find out you will have to pay a large sum out of pocket to be treated, try talking to your provider’s billing department. Not all, but some will work with you and your family to meet your budgetary needs.







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