![]() ![]() Patients with High-Deductible Health Plans Now, how do the specifics of your patients’ insurance plans impact you? Well, given that only 21% of patient balances that aren’t collected at the time of service are ever recovered, don’t you want to know exactly how much you should be collecting from patients while they’re in your office? The only way to know what each patient owes is to understand the ins and outs of his or her insurance coverage-and to ensure they do, too. Want all this information in a handy document that you can share with your staff-and your patients? Click here to download your free copy of the PT Patient’s Guide to Understanding Insurance. Because secondary insurances can be even more confusing than primary ones, we recommend having your patients contact their secondary insurance carriers to learn more. In some cases, though, the secondary insurance also charges patients a copay, coinsurance, or deductible. If a patient has original Medicare as his or her primary insurance-and he or she also has a secondary insurance-then the secondary payer is responsible for paying that 20%. Patients who have Medicare Part B are responsible for a 20% coinsurance, which usually comes to $11–25 per visit. Coinsurance for Patients with Medicare Part B Coinsurance amounts may vary from visit to visit-depending on what services the patient receives. ![]() In this scenario, the patient would owe $40 at the time of service, and the insurance company would pay the rest of the allowed amount for that visit. he or she is responsible for a 20% coinsurance.the patient has already met his or her deductible and.the insurance plan’s allowed amount for an office visit is $200.Thus, it’s the patient’s share of the total cost. This type of out-of-pocket payment is calculated as a percent of the total allowed amount for a particular service. In most cases, copayments go toward the deductible. Patients typically pay their copays at the time of service-and, because this amount is fixed, they’ll pay the same amount regardless of the visit length. Usually, copays vary for different plans and types of services. CopayĪ copay is a fixed amount that a patient must pay for a covered service-as determined by his or her health plan. Furthermore, even after a patient meets his or her deductible, that patient may still owe you a copay or coinsurance amount for each visit. For example, if a patient’s deductible is $1,500, then his or her insurance won’t pay anything until that patient has spent $1,500 on services that are subject to the deductible (it’s important to note that not all services apply to the deductible). The deductible is the total amount a patient must pay out of pocket before his or her insurance starts to pay. With that in mind, here are some seriously helpful definitions of common insurance terminology (as well as why knowing this information-and passing it on to your patients-is good for your business): Understanding Insurance Terminology Deductible coinsurance? What’s the difference?” While it may not feel like insurance education is something you should have to shoulder, doing so may be a big benefit-both for your patients and your payment collection efforts. Now, even commercial insurance plans are hard to understand-which is why many patients (and providers) are asking tough questions, questions like, “Deductible vs. Once upon a time, only Medicare was confusing.
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