Billing Information For Patients
While our office does its best to help patients understand their financial responsibilities for services provided by our office, it is ultimately the patient’s responsibility to understand their benefits and we recommend you contact your insurance company directly with benefit questions.
If our office has a contract with your insurance company, we are required to collect any patient responsibility amounts, like copays, deductibles, and coinsurance.
DEDUCTIBLE: The amount you pay for covered health care services before your insurance plan starts to pay. For example, if you have a $2,000 deductible, you will pay the first $2,000 of covered services out of pocket.
After your deductible has been met, you will be required to pay a co-payment or coinsurance for covered services. Your insurance company will pay the remainder.
CO-PAYMENT: A fixed amount required payment for a covered health care service after you’ve paid your deductible.
Co-payments (often referred to as “copays”) can vary for different services within the same plan, like medications, lab tests and visits to specialists.
COINSURANCE: The amount, generally expressed as a fixed percentage, an insured must pay toward a covered claim after the deductible has been met. It is very common in medical insurance.
One of the most common coinsurance breakdowns is the 80/20 split. The insurance company pays 80%, the insured (patient) pays 20%.
A coinsurance provision is similar to a copay except copays require the insured (patient) to pay a set dollar amount at the time of the service, and coinsurance is a percentage amount
SCOPE PROCEDURE BREAKDOWN: During your office visit your provider may determine based on your symptoms, physical exam and/or history that an in-office procedure called Diagnostic Endoscopy (scope) is medically necessary. This procedure provides valuable clinical information when there may be a condition or disease in the nose or throat that is not adequately visualized on routine exam.
Declining this procedure may lead to an incorrect or lack of diagnosis, which may adversely impact the patient’s treatment and outcome.
The procedure is done using a fiber optic or rigid endoscope. Nasal spray is used to shrink and numb the nasal membranes. The scope is usually passed through the nose so structures in the nose, mouth, and throat can be directly observed.
Please note that insurance companies consider diagnostic endoscopy an in-office surgical procedure and may assign additional financial responsibility to the patient when processing a claim.
QUESTION: “I paid my copay when I was in office, why am I being charged an additional copay?”
ANSWER: When a patient is being seen by multiple providers on the same day, some insurance companies apply 2 copays = 1 per provider/claim
Additional Links:
https://www.healthmarkets.com/resources/health-insurance/difference-copayment-coinsurance