Dr. John B. Hudson, MD., P.A. |  2071 Dundee Drive | Winter Park, Florida| 32792 | Phone 407-628-4188

Health Insurance Terms & Information

As an Office Manager, I find that many patients have questions about their insurance coverage. Some patients do not fully understand how their insurance works or what their coverage means. I will try to help answer some of those questions in this article. What is a Deductible?  A Deductible is an amount of money, determined by the insurance company, that the patient is responsible to pay towards their medical charges before their insurance company will make any payment. For example: If you have a $500.00 deductible, then you are responsible to pay the first $500.00, at your insurance company’s discounted rate, of your medical charges starting at the beginning of the year. Most insurance companies will renew the deductible status at the beginning of each year. Once you have paid that $500.00 for your deductible, then you may only owe a Co-Insurance amount for the remainder of the calendar year. What is Co-Insurance? Co-Insurance is a percentage of the insurance company’s payment rate that a patient is responsible to pay to a medical provider for services rendered. Usually, the Co-Insurance kicks in after a patient has met their deductible for the year. For example: You have a $500.00 deductible with an 80/20 policy. This means that after you have met your $500.00 deductible, your insurance company will pay your medical fees at 80% of the discounted rate and you will be responsible to pay the other 20% of the discounted rate. This benefit will remain in effect until the end of the calendar year. Percentages can change with different insurance companies and different plans. Some insurance plans will cover at 100% after you have met your deductible. Which means you will not owe any money once you have met your deductible for the year. Co-Insurance can be 90/10, 80/20, 70/30 or even 50/50. All depending on your insurance plan benefits. It is always good advice to have any procedures you need to be done after you have met your deductible and before the end of the calendar year. This way you will save money. What is a Co-Pay? A Co-Pay is a fixed amount of money that a patient is responsible to pay a medical provider for services rendered. Most Co-Pays are owed for office visits to doctors. They can range from $10.00 to $50.00 or more, depending on what your insurance company benefits are. If you have a Co-Pay for an office visit, your insurance company requires you to pay that amount to your medical provider for an office visit. Most times, the Co-Pay will cover all services rendered at an office visit. A patient only pays one Co-Pay per office visit. Most insurance companies will have different amounts for an office visit with your primary care doctor and your specialty care doctor. What is an Out of Pocket Expense? This is the maximum amount of money a patient will pay for their medical services in a calendar year. Once a patient has reached or “met” their Out of Pocket Expense for the year, their insurance company pays all medical bills at 100% for the remaining calendar year. For example: if you have a $2,500.00 Out of Pocket Expense, then you will never pay more than $2,500.00 as your part of all your medical expenses for the year. You may pay less, but never more. $2,500.00 is the most money you would have to pay for your medical expenses for that year. Your deductible, co-insurance and/or co-pays all apply towards your Out of Pocket Expense. To find out how your insurance coverage works, call your insurance company.
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Family Practice Medical  Office of

John B. Hudson, MD., P.A.

Providing Healthcare with a Caring Thorough Approach
Serving Winter Park, Casselberry, Baldwin Park and Maitland