Understanding Your Insurance Benefits
WRITTEN BY KATELYN CROMER
Insurance benefits can be challenging to understand. Knowing the difference between insurance terminology can be tricky, especially when you receive a bill. This can be frustrating and upsetting, so let’s review common terminology you might see in your statement.
A deductible is a set dollar amount your insurance pays yearly that must be met before your insurance pays for care. For example, Medicare has a $240 deductible this year for part B coverage and will start over every year on January 1st. Some supplement plans cover the Medicare deductible, and some do not. Make sure you are aware of what your supplement policy covers.
Some insurance policies charge coinsurance. Coinsurance is a set percentage of a service the patient is responsible for after insurance processes. For example, Medicare patients owe 20% coinsurance for every visit after the deductible has been met. Supplement policies usually cover this in full after the deductible is met, but again, some may need to ensure you know what your supplement policy covers.
A copay is a set dollar amount for which a patient is responsible for a specific service. For example, your insurance may say you have a $40 copay for an office visit. This must be paid until your out-of-pocket expenses are met.
Please contact your insurance company directly and ask them what your deductible, coinsurance, copay, and out-of-pocket expenses are for the year. This can help alleviate any confusion or frustrations about your benefits and give you a clear understanding of what you may be responsible for paying.
Does Your Health determine what you pay for a service?
No – When a Your Health provider sees you, we submit the claim to your insurance company for processing. Once your insurance company processes the claim, they will send us the payment and a copy of the EOB. EOB stands for Explanation of Benefits, which explains precisely how the claim was processed, from how much your insurance covered to how much the patient owes for the visit. We can then post the claim payments and outstanding balances to your chart accordingly, and we will then send you a statement that shows your balance due.
I understand my bill and would like to pay it without calling, can I do that?
Yes, you can quickly and easily pay on the patient portal. You can have the office register you for the online portal or follow the link on your statement to make your payment and register for the portal for all future payments.
If I need help understanding my bill, can you help explain it to me?
Yes, we have a Business Office Manager for each region who is highly trained in insurance and billing and will be happy to assist you with all billing questions. Their valuable insight can help break down your statement and offer convenient ways to make your payment.