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Thread: coinsurance and decuct ?

  1. #1

    Default Coinsurance and Deductible ?

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    Engelwood, CO


    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. #3


    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. #4

    Red face

    Thanks for the help!!!

  5. #5
    Join Date
    Apr 2007
    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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