Co pay: The amount you pay up front to your doctor's office or hospital for services. Often times co pays for specialists, MRI's, or CT's are higher. Co pays do not always cover everything that is done at a doctor appointment or even a MRI or CT, so it is possible that you may get a bill later (keep an eye out for those EOB's so you are prepared for the bill that may follow). Every plan is different so if you're unsure about yours email me and we can take a look at it.
Co Insurance: Very similar to a co pay, in that it is paid by the patient, but it's typically a percentage of the allowable charges and not a flat fee like a co pay.
Example: 80/20 plan means the insurance pays 80% of the allowable charges and the patient pays 20% of the allowable charges. So if the services billed totaled $500, but the allowable charges are $350 the insurance company would pay $280 and you would owe $70. **Side note: sometimes you have to meet your deductible and then your co insurance, so that can get confusing. If you're not sure email me and we can check it out.
Deductible: This is the amount out of pocket a patient pays before the insurance carrier will pay anything.
DME: Durable Medical Equipment. DME benefits cover things like knee braces, nebulizers, wheel chairs etc. Often times you must meet your deductible before insurance will pay for DME, sometimes it goes toward your Co Insurance...but again every policy is different, so if you have a question about your DME benefits email me and we can discuss it.
Please email your questions regarding your health insurance policy to deargabbyinsurance@yahoo.com
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