Understanding Your Insurance

Copay

A copayment, or copay, is a fixed amount you pay at the time of service for certain covered healthcare services. For instance, you might have a $20 copay for a primary care visit or a $10 copay for generic medications. The insurance company then covers the remaining costs.

Deductibles

A deductible is the amount you are responsible for paying out of pocket before your insurance coverage begins. For example, if your deductible is $1,000, you must pay that amount before your insurance starts covering eligible expenses.

Coinsurance

Coinsurance is the percentage of the cost of a covered service that you are responsible for paying after meeting your deductible. For example, if your coinsurance is 20%, you would pay 20% of the covered service's cost, while the insurance company covers the remaining 80%.

Premium

A premium is the amount you pay, typically on a monthly basis, to maintain your insurance coverage. It is important to pay your premiums promptly to keep your coverage active.

Network

Insurance plans often have a network of healthcare providers and facilities with which they have negotiated contracted rates. In-network providers have agreed to accept the insurance company's predetermined fees, usually resulting in lower out-of-pocket costs for you.

Preauthorization

Some insurance plans require preauthorization for certain services or treatments. Preauthorization involves obtaining approval from the insurance company before receiving the service to ensure it is medically necessary and covered under your plan. Failing to obtain preauthorization when required may result in denied claims.