Being a doctor in a small office I’ve had the opportunity to work and learn numerous aspects of running things. Insurance is the primary aspect I hear questions about on a daily basis. It seems as though each day insurance policies are changing. Regardless if you have a brand new policy midyear, or have maintained your current policy, there are a handful of terms you should understand.
All medical offices have a fee schedule. A fee schedule is a list of services and the amount billed to an insurance company. These fee schedules are determined based on location and other aspects which as a patient you could care less about. On a very basic level, paying for insurance gives you the privilege of paying that companies rates.
Medical office rate for exam: $100
Blue Cross Blue Shield Rate for same exam: $80
If you have BCBS insurance, you can only pay up to $80 for that exam. You get the $20 discount.
It's tough navigating through the challenging world of health insurance especially if you do not have the basic terminology down. Below are some common terms and definitions to help you understand health insurance. Feel free to save this blog for future reference!
The premium is the amount you (or your employer) pay for your health insurance plan whether you use medical services or not. In most cases, it’s paid monthly, but can be paid every 3 months or yearly.
A deductible is the amount you must pay before the health plan starts paying for your covered services. For example, if your deductible is $1,000, your plan won’t pay for some services until you’ve paid $1,000. In most cases, the higher your deductible, the lower your premium. The lower the deductible, the higher premium.
Coinsurance is the percentage of the cost that you must pay for a covered service. It applies after you meet your deductible.