The language of medical insurance

Premium: The amount that you and your employer pay each month to be enrolled in medical, dental and vision insurance.

Deductible: The amount that you must pay each year for certain covered health services before the insurance plan begins to pay. 

Coinsurance: After you meet your deductible you pay a coinsurance which is your share of the costs of a covered health care service. For example, if the health plan’s allowed amount for lab work is $100 and your coinsurance is 20%, then once your deductible is met you will pay 20% of 100% or $20. The health plan pays the remaining $80.

Copayment: A fixed dollar amount that you may pay for certain covered health services. Typically, your copay is due at the time of service.

Out of Pocket Maximum: The most you will pay for covered health services during the year. Copays, deductibles and coinsurance payments count toward the out of pocket maximum. One you meet your out-of-pocket maximum your plan pays 100% of the covered services for the remainder of the year.

Preventative Care: Covered services that are intended to prevent or diagnose disease while it is more easily treatable. Examples of preventative care services include screenings, check-ups, and patient counseling to prevent illnesses, disease or other health problems. Typically, in-network preventative care is paid 100% by the insurance plan.

Explanation of benefits: Anytime you receive services that count toward your deductible or out of pocket maximum you will receive an explanation of benefits from your insurance company. This is not a bill but a list of services you received, and the charges added toward your deductible and out-of-pocket maximum for the plan year.  You will receive a bill from the provider that shows the amount you owe, which should be the amount of your coinsurance or copayment. This amount is paid directly to the provider, clinic or hospital that provided your care.

If you have any further questions regarding these explanations of insurance terms regarding podiatric services, feel free to call Pueblo Ankle and Foot Care and ask to speak to our insurance verification specialist.

Wendy Taggart, PMAC & Insurance Verification