Peak Peformance Sports & Spine PT - March 2020


MARCH 2020



When you get injured, it’s not uncommon for your first thought to be, “How do I pay for this?” Luckily, health care coverage can provide the financial support you need in the event that you are injured. However, navigating the health care insurance process can be confusing and, at times, overwhelming. It’s hard to understand what you need to do, especially when words like deductible, copayment, and premium are thrown around without any indication of what they mean. That is why I want to go over a few insurance terms and explain their benefits. DEDUCTIBLE defines a deductible as “the amount you pay for covered health care services before your insurance plan starts to pay.” This means your health insurance will only cover your expenses once this amount is paid. For example, let’s say your health plan deductible is $1,000. You will have to pay that $1,000 out of pocket before your plan comes into effect. Once that deductible is paid, you’ll pay a copayment or coinsurance — don’t worry, I’ll explain these, too! — for covered services before your insurance pays the rest of the bill. Plans and deductibles vary by insurer. In some plans, for example, the deductible covers certain services, such as prescription drugs. Other plans will cover disease management programs or checkups even before you’ve met your deductible. Be sure to check your plan to see exactly

what your plan expects you to cover through the deductible.

COPAYMENT Copayment refers to an established amount you pay after you meet your deductible. For example, if your plan covers a $200 procedure and your copayment is $35, then you will only have to pay that $35 when you see your doctor for the procedure. However, you are only eligible for a copay if you’ve already paid your deductible. If you haven’t met your deductible, then you are required to pay the full $200. COINSURANCE Coinsurance functions similarly to a copayment. It refers to the percentage of a health care service you’ll pay for, but it only takes effect once you have paid your deductible. For example, if a service or procedure costs $100 and your coinsurance is 20%, then you will only need to pay $20 for that service. It’s important to keep in mind that, unlike with copayments, the amount you are required to pay with coinsurance will fluctuate based on your medical costs. A coinsurance of 20% will yield an out-of-pocket cost of $2,400 on a medical bill totaled at $12,000. OUT-OF-POCKET MAXIMUM/LIMIT While you are required to pay some of your medical costs, there is a limit to the amount you pay, which is referred to as the out-of-pocket maximum or out-of-pocket limit. This amount varies from plan to plan and depends on

your insurance provider. Once you’ve reached your out-of-pocket maximum, which includes your deductible, copayments, and coinsurance, your plan will pay 100% of any remaining costs as long as they’re for covered services. If you’re injured and require medical assistance, we don’t want you to have the added worry about what your health insurance means or what you will have to pay. We only want you to worry about taking the steps necessary to get you back to full health. I hope these helpful explanations reduce your stress and leave you confident in navigating your own health care. Please feel free to contact me if I can answer any additional question for you at or 509-972-8205 .

– Agatha Formella Billing Manager

• 1 509-453-PEAK (7325)

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