Insurance Terminology Explained
Although it is the patient's responsibility to know and understand their own insurance coverage we are here to help in any way possible. Since doctors obviously don't make the rules and policies between the patient and their insurance company, it is up to each patient to discuss any concerns directly with their insurance company.
Deductible - the amount that must be paid by each patient each year for health care expenses before the insurance company begins to pay. The exception to this are office visits that are sometimes covered by medical insurance even before meeting the deductible.
Co-insurance - Many insurance plans require patients to pay a portion of their health care costs after first meeting the deductible. This co-insurance amount is usually a percentage of the total allowable fee up to the patient's out-of-pocket limit. The most common co-insurance amount is 20% to be paid by the patient.
Out-of-pocket Limit - Most insurance plans will pay all of the costs after the deductible and coinsurance is met above this limit.
Secondary Insurance - Some patients are covered by more than one insurance plan. Secondary insurance carriers are billed only after the primary insurance carrier has paid their portion of the covered expenses. Secondary insurance may possibly cover the deductible and co-insurance amounts not paid by the primary insurance.
Preauthorization - Many insurance carriers require that some procedures be pre-authorized. A pre-authorization will determine if the proposed medical procedure/test is a covered expense under the insurance plan. Pre-authorization does not guarantee payment by the insurance company!
Vision Plan or Medical Insurance - Eye doctors are the only health care providers that must follow two different sets of insurance regulations. Click Here for details.