Insurance Deductibles & CoInsurance

understanding deductibles, co insurance, and allowed fees some insurance policies require the patient to pay a deductible before the insurance company begins covering services the deductible amount varies depending on the insurance company and the specific policy often, once the deductible is met, the patient will still have a co insurance this means the insurance company covers a percentage of the allowed amount, and the patient is responsible for the remaining percentage if the deductible applies to chiropractic services , the insurance company will not pay anything toward those services until the deductible has been met some insurance plans have a set co payment after the deductible is met this is why it is very important to verify benefits carefully and confirm exactly how the plan processes chiropractic claims allowed fees are the maximum amounts an insurance carrier allows for a specific service these allowed amounts are what we use to calculate the patient’s responsibility per visit example 1 mary jones deductible $500 met $400 remaining deductible $100 this means ms jones must pay the first $100 of services in our office before meeting her deductible after she pays the remaining $100 , her insurance will begin to cover 80% of the allowed amount ms jones will then only be responsible for the remaining 20% of the allowed fee, instead of the full allowed amount example 2 lisa smith deductible $1,000 met $735 remaining deductible $265 insurance coverage after deductible 70% patient responsibility after deductible 30% this means ms smith must pay the next $265 of covered services before her deductible is met after that, her insurance will pay 70% of the allowed amount ms smith will be responsible for the remaining 30% of the allowed fee important note when a patient has a high deductible, especially $2,000 or more , it may be more affordable to offer them the option to be a cash patient this is especially true for maintenance care, since maintenance treatment often does not need to be billed through insurance