Deductible, Coinsurance & Copay in Medical Billing

Deductible Coinsurance Copay

Deductible CoInsurance Copay what is patience out-of-pocket patients? Expenses for medical care that are not reimbursed or paid by payer are called out-of-pocket. These expenses are patient responsibilities apart from insurance premiums out-of-pocket includes deductible co-payment.


1. Deductible: 

It is fixed amount that patient agrees to pay as per contract of policy before insurance begins to pay to provider

 [ For example ]  if patients deductible is $1,000 as per policy contract patient need to pay all medical bills until it reaches thousand dollars these thousand dollars our patient responsibilities apart from insurance premium after deductible is met insurance covers medical charges partially.

2. Coinsurance: 

It is applied towards patient responsibility as per patients contract Coinsurance it is the percentage amount of medical expenses that patient shares with the insurance post deductible charges are met.

 For example ] per policy contract if patients Coinsurance is 30% then insurance reimbursed 70% of medical bills and remaining 30% would be patient responsibility as Coinsurance Copayment

3. Copay 

It is the amount that patient pays directly to provider before services are rendered insurance determines Copay charges as per policy contract based on type of service these charges are applied to patient responsibilities apart from Deductible and Coinsurance.


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