Plan Premiums are the “entry fees” for health insurance and are paid by all policyholders. If you get your Health Care through your employer, a portion of your premium may be paid by the company. Premiums are simply the cost of purchasing an insurance policy. They do not apply to your deductible, and do not apply directly to the cost of your care.
Deductibles are the cumulative amounts each covered individual or family must pay before an insurance plan begins to pay out against claims. Individual health plan policyholders pay for their Health Care in full until their cumulative expenses meet their deductible amount. After meeting their deductible, insurance pays for all or a percentage of Health Care costs, depending on whether or not the plan requires co-insurance (see below). For example, if your plan has a co-insurance requirement of 20%, once your deductible has been met, you pay only 20% of costs going forward, until the maximum out-of-pocket limit is reached, after which your insurance plan pays 100% of costs.
Family health plans have both individual and family deductibles. Once an individual meets their individual deductible amount, Health Care expenses are then applied to their family deductible until that is also met. Health Care expenses of other family members are treated the same way. Once the family has collectively met its family deductible, insurance pays for all or a percentage of Health Care costs, depending on whether or not they have a plan requiring co payments or co-insurance. For example, If their plan has a co-insurance requirement of 20%, the policyholder pays only 20% of costs going forward, until the maximum out-of-pocket limit is reached, after which insurance pays 100% of costs.
Co-payments (or “co-pays”) are flat fees for receiving care, paid by the patient at the time of service, with the remaining balance covered by their insurance company. Copayments usually DO NOT count toward your deductible amount.
Co-insurance means that costs are shared between the policyholder and insurance provider, with a typical plan requiring the policyholder to contribute 20% of all costs. Once the policyholder’s expenses reach an out-of-pocket maximum, costs are 100% paid by the insurance plan.
If You Are Uninsured
If you do not have health insurance or if your insurance policy does not cover an examination or procedure that you still wish to have, you should ask your provider about self-pay pricing during the scheduling or pre-registration process. Most providers that work closely with insurance carriers are trained to assist patients in determining possible out-of-pocket expenses. Providers may also work with you on a reasonable payment plan if/when needed. Please inquire during the scheduling or pre-registration process and have someone review your insurance benefits and how they apply to diagnostic imaging.
For further information, contact Billing@AdRad.com or call Advanced Radiology’s Billing Specialists at 1.203.696.3692.