coinsurance and decuct ?

[nugs2121]

Coinsurance and Deductible ?

what does it mean when the insurance company states the pt.'s coinsurance is subject to their deductible and copay?
_________________

 

[bonzaibex]

It simply means that the patient's responsibility on any given claim is subject to plan deductible not yet met along with any appropriately assessed co-pay. Patient may owe a co-pay for an E&M code + have a deductible to meet on any non-E&M coded services.

Becky, CPC

 

[tadavis]

co-ins in a nutshell means example--pt have a 80/20 plan--the ins co pays 80% and the pt's co-ins is 20%--it has nothing to do with the copay, that is a seperate payment that is due at each office visit--it could be that the co-ins is due until the deductible is met

 

[nugs2121]

Thanks for the help!!!

 

[murphyrrm]

Co Insurance is for policies that affect patients that has a PPO and choose to go Out of Network. And the Deductible is the amount based on the patients policy that must be met before the Insurance pays their % of an allowed amount for any procedured performed.
Most deductibles are not met at the begining of each year. Example: 1/1/2011 patient comes in to see a provider for E/M with Xrays (L/spine (2 views)
Deductible $500.00
COINS 80/20
Your Bill Bill amount
99215 -25 $175.00
72100 115.00
$290.00
Just because you bill $290.00, it does not mean that that total amt will go toward satisifying the $500.00 deductible (must wait on EOB). Whatever the Insurance applied toward the deductible (lets say $150.00) that is the patients responsibility up to the total bill amount. Once the deductible has been met by bills submitted to a payer by you or any number of other providers and the members $500.00 has been reached, then the Insurance will pay 80% of the allowed amt for each procedure performed. Example:

CPT Bill amt Allowed 80% 20%
99215 -25 $175.00 100.00 80.00 20.00
72100 115.00 60.00 48.00 12.00
totals $290.00 $160.00 $128.00 $32.00