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coinsurance and decuct ?

  1. Default Coinsurance and Deductible ?
    Medical Coding Books
    what does it mean when the insurance company states the pt.'s coinsurance is subject to their deductible and copay?
    Last edited by nugs2121; 07-27-2010 at 08:34 PM.

  2. #2
    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

  3. Default
    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

  4. Red face
    Thanks for the help!!!

  5. #5
    will join Pasadena,Ca
    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
    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

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