In order to help you better understand some of the more complicated terms used in insurance, please find below a list of commonly used words and phrases:
Coinsurance
After the deductible is met for the year, the coinsurance is the percentage the patient is responsible for on their medical services.*An easy example is Medicare. Once the deductible is met, Medicare will pay 80% and the patient will pay 20%.
Copay
A flat dollar amount owed for an appointment, usually one per service date. Copays do not count toward deductibles.
Deductible
A specified amount of money that the patient must pay before an insurance company will pay a claim. This amount is plan specific and renews each year.
HRA
HRA stands for Health Reimbursement Account. This account is coordinated with the insurance company and they disburse the funds.
HSA
HSA stands for Health Savings Account. The patient is responsible for this account and will disburse the funds themselves.
Non-Covered Benefit
Services that are not processed or paid by the insurance company whatsoever. Non-covered services do not equate to deductible, copay or coinsurance, ever.
Spend Down- Straight Medicaid
A deductible set by Medicaid that renews each month. If the patient has not met the spend down, we are not to bill Medicaid. The patient is responsible for taking the bill to their caseworker to track in CHAMPS.
