INSURANCE TERMS

UNDERSTANDING INSURANCE

ALLOWED AMOUNT: The amount an insurance company will pay to reimburse a health care service or procedure. The patient will typically pay the balance if there is any remainder.

APPLIED TO DEDUCTIBLE (ATD): The amount of money a patient owes a healthcare provider that goes to paying their annual deductible (See “Deductible”). A patient’s deductible varies and depends on that patient’s insurance policy.

Deductible—the amount of money you must pay each year to cover eligible medical expenses before your insurance policy starts paying.

CO-INSURANCE: A type of insurance arrangement between the payer and the patient that divides the payment for medical services by percentage. While this is sometimes used synonymously with a co-pay, the arrangements are different: While a co-pay is a fixed amount the patient owes, in a co-insurance, the patient owes a fixed percentage of the bill. These percentages are always listed with the payer’s percentage first (eg a 70-30 co-insurance).

Co-Pay: A patient’s co-pay is the amount that must be paid to a provider before they receive any treatment or services. Co-pays are separate from a deductible and will vary depending on a person’s insurance plan. A flat fee for certain medical expenses (e.g., $10 for every visit to the doctor), while the insurance company pays the rest.

Maximum Out of Pocket: The amount a patient is required to pay. After a patient reaches their maximum out of pocket, their healthcare costs should be covered by their plan.