“Understanding insurance copays, coinsurance and deductibles is getting even more confusing for Boston patients”, commented Massachusetts Ophthalmologist Francis D'Ambrosio Jr., M.D. of D'Ambrosio Eye Care. Due to the ever-increasing cost of healthcare, many patients find themselves with higher copays, coinsurance and/or deductibles. It can be confusing to understand all of these terms but it is a very important part in understanding your medical bills.
A co-payment (or co-pay) is the flat amount the patient pays each time they see their medical provider. Your insurance establishes these fees up front and many insurance companies print this information on your insurance ID card. Coinsurance and co-payments are not the same thing. A co-payment is a set amount that you pay each time you see your medical provider. On the other hand, coinsurance is typically a certain percentage of the provider’s fee that is owed by the patient. For example, some insurance companies pay 80% and the patient is responsible for the remaining 20%. That 20% is the coinsurance that is due from the patient per the insurance company. The amount the patient owes will vary based on the fee for the service.
A deductible is a fixed amount of money that the patient must pay before the insurance company begins making payment. For example, let’s say a patient has an insurance policy with a $100 deductible. If the insurance considers $300 of the services provided as “covered” services, the patient must pay $100 and the insurance will pay the remaining $200. Deductible amounts are typically calculated yearly so that means that beginning January 1st of each new calendar year, you must meet your deductible before your insurance will issue payment. If you have any questions on your billing from D'Ambrosio Eye Care, please contact us at 800-325-3937 and we will be happy to explain in detail any charges for you
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