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By: Suzanne Berman, MD, FAAP & Angelo Peter Giardino, MD, PhD, FAAP All health insurance requires consumers to pay some of the cost of covered health care services. This is called "cost sharing" or "out-of-pocket" costs. Cost sharing varies with different types of health plans, but most will have a copayment, coinsurance or deductible amount. Types of Cost Sharing Arrangements & SituationsHow much is paid by the insurance company, and how much is your responsibility, depends on your plan's cost sharing arrangement:
To add to the complexity, different cost-sharing arrangements may apply depending on different situations:
Children's Preventive ServicesChildren's preventive services, such as well-child checkups and immunizations, may or may not be covered without cost sharing. You should carefully review your plan's benefit description for details. The best time to review a plan is before you sign up with it. Methods of PaymentBefore visiting your child's doctor, check the accepted methods of payment for your out-of-pocket expenses. Options for payment may include cash, check, or credit card. Remember to bring your insurance card with you to each visit. Additional Information:
About Dr. Berman:Suzanne Berman, MD, FAAP, is co-founder and managing partner of Plateau Pediatrics, the first NCQA-certified level 3 patient centered medical home in Tennessee. She serves the American Academy of Pediatrics (AAP) in a variety of roles―including the executive committee of the Section on Administration and Practice Management and the Committee on Child Health Financing. Dr. Berman frequently contributes to AAP projects and publications regarding medical home practice transformation, rural health, coding, data mining, and policymaking. She and her husband have three sons. About Dr. Giardino:Angelo P. Giardino, MD, PhD, MPH, is the Wilma T. Gibson Presidential Professor and Chair of the Department of Pediatrics at the University of Utah's School of Medicine and Chief Medical Officer at Intermountain Primary Children's Hospital in Salt Lake City, Utah. He holds subspecialty certifications in Pediatrics and Child Abuse Pediatrics from the American Board of Pediatrics. He is also a Certified Physician Executive (CPE) within the American Association for Physician Leadership. He completed the Patient Safety Certificate Program from the Quality Colloquium, is certified in medical quality (CMQ) as designated by the American Board of Medical Quality and is a Distinguished Fellow of the American College of Medical Quality. Within the American Academy of Pediatrics, Dr. Giardino is a member of the Committee on Child Health Financing, the Council on Child Abuse and Neglect, and the Council on Children with Disabilities. The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Which is the percentage the patient pays for covered services after the deductible has been met and the copayment has been paid quizlet?Terms in this set (61)
After the yearly deductible is met, the patient shares the bill with the insurance company in what is called co-insurance. After the deductible is met, the patient must pay 20 percent covered medical expenses, and the insurance company pays 80 percent.
What does 80% coinsurance mean?One definition of “coinsurance” is used interchangeably with the word “co-pay” – the amount the insurance company pays in a claim. An eighty- percent co-pay (or coinsurance) clause in health insurance means the insurance company pays 80% of the bill. A $1,000 doctor's bill would be paid at 80%, or $800.
Which is the amount for which the patient is financially responsible?Health Insurance & Claims Chapter 2. |