What is a deductible?
Generally, your deductible is the amount of money that you will have pay out of pocket before your insurance starts to pay for your healthcare expenses based on your plan's coverage percentage.
What is a copayment?
A copayment is a payment required at the time of service by your insurance carrier. Copayments are made directly to your healthcare provider.
What is coinsurance?
Coinsurance is the amount of money that the patient is responsible for after your insurance carrier has paid their percentage of your healthcare costs. Coinsurance generally only applies to shared costs plans, often known as 20/80 or 10/90 plans. Under these plans, healthcare costs are split between the patient and the insurance carrier based on a specific percentage split like 20% patient/ 80% insurance carrier.
What is coordination of benefits?
Coordination of benefits is an insurance industry term that generally refers to processing issues when the patient has insurance coverage under multiple plans. Every insurance carrier is required by law to follow certain guidelines for determining which plan is considered primery, secondary, and sometimes tertiary. To do this, your insurance company may request additional information from you about other insurance coverage, if any, before processing any of your claims.
It is very important to send this information back as soon as possible because your insurance carrier will hold you responsible for 100% of your healthcare costs until you return the requested information. In addition, if payment is not made to your provider according to their payment policy, you may incur additional finance and/or collection costs.
For coordination of benefits issues, it is not normally not required for your healthcare provider to resubmit your claim to your insurance carrier. Once your carrier receives the requested information, they will automatically process your claim.
How does the billing process work when I have multiple insurances?
Your healthcare provider will collect all of your information for each insurance plan. Your healthcare provider will first submit your claim to your primary insurance, then the secondary, and so on. It is important to remember that your claim cannot be submitted to any insurance carrier until the claim has been processed by all of the insurance carriers above it. So a secondary insurance cannot process a claim until the primary has processed and a tertiary insurane cannot process the claim until both the primary and secondary have processed the claim.
This is important because many families have a state-assisted plan as their secondary insurance plan. For these families, it is imperative to make sure your primary insurance carrier processes your claim in a timely manner so that the state-assisted plan can cover any remaining costs that may be the patient's responsibilty.