What is a co-payment and coinsurance?
For example, you may have a health plan that has $100 co-payment for emergency room visits, with a 25% coinsurance after you have made the co-payment. If the total cost of your emergency room visit is $500, your total share-of-cost will be $200. This is the sum of the $100 co-payment and 25% of the $400 balance. The co-payment amount is typically deducted from the total expense before your coinsurance amount is calculated. When reviewing your health plan, make sure to clearly understand the difference between the co-payment and the coinsurance for each of the covered services listed under the plan description. The most common complaints from consumers about their health plan come from a lack of understanding between these two key components of most medical insurance policies. Here are some common misunderstandings that apply to the differences between these two commonly used terms: A co-payment will often be required for each visit or service for which there is a co-payment required, even after you have met the calendar year maximum. Many co-payments are required in addition to the plan deductible and do not apply to that deductible. A co-payment for an office visit may vary depending on the type of physician and if they are a participating provider with your health insurance company. Co-payments are usually collected by the health care professional at the time of service. Coinsurance will not apply until after you have met your plan’s calendar year deductible. Some services may waive the plan deductible, but these will be clearly stated in the plan details. Your coinsurance is calculated after the claim is submitted to the insurance company by your physician. The insurance carrier will pay their percentage of the claim and the health care provider will bill you separately for your coinsurance amount. Higher coinsurance percentages may be required if you use non-network physicians. The coinsurance may not be the same percentage for all covered medical services. 1 CommentLeave a comment |
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What is a co-payment and coinsurance?
A co-payment is the specific, set dollar amount that an insured member must pay toward their health care costs per visit. This usually applies to the most commonly utilized type of medical treatments, such as physician and emergency room visits. Most health plans that offer prescription drug benefits will also assign a co-payment for each prescription, and the set co-payment amount may vary depending on the class of prescription. Many people confuse “co-payment” with “co-insurance”, since they both basically mean the same thing ? the insured member’s contribution. The best way to distinguish between the two is that “co-payment” is usually represented as a set dollar amount, while “co-insurance” is represented as a percentage. Some medical insurance policies may have both coinsurance and co-payment requirements that apply to the same medical expense.
What will happen if I do not pay my doctor my co-insurance and co-payment because he didn’t listen to me at all? My doctor hardly even bothered to talk to me at all during my entire visit and he didn’t seem like he was listening to me at all. He charged me 275$ for that short visit. Another time when I was scheduled for a follow up to an earlier meeting he charged me the same amount as well. My health insurance company is paying the largest part of this, but with co-insurance and co-payment it still adds up to around $100 for me to pay for both visits. What will happen with my health insurance company if I do not pay him the remainder as I didn’t feel he did his job? Will I get into trouble with my health insurance company and will they be able to cancel my contract? I mean that doesn’t seem fair, if the doctor didn’t perform his job well enough.
Comment by Nicole — June 2, 2009 @ 9:20 am