I have had some interesting interactions this past week and wished to take a step back to discuss health insurance generally. I’m little by little learning that the language regarding medical insurance is very international for some folks and they are having difficulty understanding the conditions that are used. I wish to take this possibility to educate folks on some of the essentials and how it belongs to you, the consumer. Bricon Associates Pte Ltd
So lets start off with basic principles of insurance terminology in the most simple form- in ok bye to how it takes on out in the medical world.
Premium- this can be the amount of money you pay to acquire health insurance (your safety net), can be paid monthly, quarterly, or all at once.
Deductible- this is the amount of money that you must pay before your insurance even commences to cover costs. You will discover fine details associated with this but in my brain, this is how I believe about it. These can vary from a few hundred dollars to $20, 000, depending on what style of insurance that you have.
Co-insurance- after you have paid the complete amount toward your deductible (the amount of money you pay prior to your insurance actually kicking money in), your co- insurance represents the quantity of dollars you are still accountable for. Discussing use an example to show this. If you see a doctor and the bill is hundred buck, the first hurdle is actually you have paid your deductible yet or not. When you have paid the deductible amount, the insurance carrier will grab a portion of the costs and the rest you will owe. If your Co-Insurance is 20%, then you are in charge of twenty percent of the bill. In such a case its $20. If your Co-Insurance is 35%, then you are in charge of 35 dollars. The greater the co-insurance, the more money you will have to kick in for medical services.
Away of Pocket Maximum- this is the amount of money in a given YEAR, that you will likely need to pay on top of health insurance. Some plans include your deductible towards this amount. Some do not. The other information here is that your insurance company can deem certain services not included in this out of pocket sized maximum. For instance, if you really hurt your knee and need an MRI, your insurance company know that the MRI is not a protected service which means that they will not pay for it. The MRI bill will come to you together with all the other charges that you have built up.
IN- Network/ OUT of Network- This appears to be the region of most confusion for most patients. The easiest analogy I use is to think of discount membership stores like Costco or Sam’s Club. Once you have a regular membership to either place, these products they sell have recently been given the green light by Costco or Sam’s, in an agreed price, and then your you the consumer can purchase it from the store, typically at a discounted rate. If a product that you want is not at Costco or Sam’s, then you are heading to pay full price at another store. IN- network means that the doctors office has decided to conditions set by the insurance carrier, and you the patient only pay a pre-determined amount of money based on these negotiations. Most times- your charge is a nominal fee. OUT of network means that your doctors office is NOT REALLY a section of the insurance plan. The fees associated with this visit are in the end your responsibility and often your insurance carrier pays you again for services rendered. HARDLY EVER assume that your doctors office is IN NETWORK. I usually assume OUT of network until I see it on paper.
Co-Pay- The amount of money that you must pay at the doctors office. Think of this as an entry fee. Main care doctors have a low copay. Specialty doctors and the Er have high Copays. The copay is devised as a financial barrier. The insurance company and the medical practice wants to be sure that the patient are arriving in for something truly medical related. You would be surprised at how many people that contain $0 co-pays come to the doctor for a hang up nail, or non medical related issues. It’s a way of allocating resources as well. For each hold nail, there is also a sick patient that may have not recently been seen. Some patients were commenting to me about copays during the past, thinking that this money goes right into our pockets as supplementary income. Rest guaranteed, I tell them, the amount of money accumulated barely covers the electricity bill.