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The amount of the billed charge the insurance company deems is payable by the plan.
Coinsurance refers to money that an individual is required to pay for services, after a deductible has been paid. Coinsurance is often specified by a percentage. For example, the insurance will only pay 80% of what they allow for a procedure, the patient is responsible for the 20% that is left over.
Copayment is a predetermined (flat) fee that an individual pays for health care services, in addition to what the insurance covers. For example, some insurance companies require a $30 copayment for each office visit, regardless of the type or level of services provided during the visit.
The deductible is a set amount a patient must pay for allowed charges before insurance covers the costs. The patient is only responsible for the allow amount per procedure that is applied to the deductible. After you have met your deductible, you will be responsible for any coinsurance or copayments.
Explanation of benefits (EOB)
An explanation of benefits is the insurance company's written explanation regarding a claim, showing what they paid and what the client must pay. You will either receive these statements by mail or you can retrieve them online.
In-network refers to a provider or a health care facility that is part of a health plan's network with which it has negotiated a discount. Insured individuals usually pay less when using an in-network provider, because those networks provide services at lower cost to the insurance companies with which they have contracts.
Maximum dollar limit
The maximum amount of money that an insurance company will pay for claims within a specific time period. Maximum dollar limits vary greatly. They may be based on or specified in terms of types of illnesses or types of services. Sometimes they are specified in terms of lifetime.
A medical procedure or service must be performed only for the treatment of an accident, injury or illness and is not considered maintenance care, experimental, investigational or cosmetic.
This phrase usually refers to physicians, hospitals or other health care providers who are considered nonparticipants in an insurance plan. Depending on an individual's health insurance plan, expenses incurred by services provided by out-of-plan health professionals may not be covered, or covered only in part by an individual's insurance company.
A predetermined limited amount of money that an individual must pay out of their own savings, before the insurance company will pay 100% for an individual's health care expenses.
A pre-existing condition is a medical condition that is excluded from coverage by an insurance company because the condition was believed to exist prior to the individual obtaining a policy from the particular insurance company.
If you have any questions regarding your chiropractic benefits you can contact your insurance company or give us a call, we will be happy to answer any questions you might have.