12/17/2025
PSA! We are entering into a new year, and those who have health insurance, most will begin a new deductible and out of pocket. I would like to help those who do not understand how this works. This does not pertain to medicare patients. I RECCOMMEND YOU CREATE A MEMBER ACCOUNT ONLINE WITH YOUR INSURANCE, IF YOU DON'T HAVE ONE!!!
EXAMPLE:
If you have a deductible and no copay, you will owe your insurances "allowable" charge when you go to your dr. You will pay the allowable charges until your deductible is zero. Your insurance will pay NOTHING until the deductible is met. So if you do not pay the provider, they get ZERO dollars for the service they provided you!!!! So be prepared to pay something.
Once your deductible is zero, you will then pay your coinsurance. MOST plans have a 20%. This means, you will pay 20% of the insurances allowable charge until the oop has been met. At this time your insurance will pay 80% of that allowable charge.
Once you have reached zero on your out of pocket, your insurance will then pay at 100% of the allowable charge.
***** allowable charge***** your provider is in a contract with your insurance, if they are in network. When they sign the contract, they are given a fee schedule. Your provider is not allowed to collect more than the set fee schedule. And the insurance will not pay more than the set fee schedule. So even if your provider "charges" $100 for a service, the insurance may only allow $50 for that service.
I know this is a lot, but if you have questions, shoot me a message. As a biller, it is so helpful when a patient understands their benefits.
MISTY :)
