DEDUCTIBLES
Deductibles are patient responsibility amounts set by your insurance company. Deductibles are portions of your claims which are not paid by your insurance even though they are approved services. The most basic setup is a yearly deductible. Aside from this, some insurance have a deductible per diagnosis. Invoiced services have to be assigned to the deductible prior to the insurance issuing any payments for your medical care. Deductibles reset yearly, so if you have paid your deductible for 2007, once 2008 hits the clock you will have a brand new deductible to pay for.
Your deductible for a year can vary from $135.00 a year (like Medicare on 2008) to several thousand dollars. In basic terms this means, if your deductible is $500.00 (consider yourself fortunate) this amount has to be applied to your approved services before your insurance pays anything for your claims. If you have medical services earlier in the year you will very likely be paying the doctor for most of those services (if your policy has deductibles). Say your claim is for $200.00, of this your insurance “allows/approves” $150.00, if your deductible is $500.00 then your services for this date will be your responsibility to pay. In this case the whole $150.00 approved by your insurance. Since the deductible is a cumulative amount, now you will have $350.00 remaining to be assigned to future services for which you will be invoiced by your doctor. Once all approved services have amounted to the total deductible, the following services should be processed and paid either partially or in full according to the particular policy’s benefit scheme.
Note that deductibles are a way for the insurance to make the insured pay for the difference between the high premium plans and the lower premium plans. Lower premium plans normally carry higher deductibles and more restrictions.
Next we will be discussing CO-INSURANCE