Why do we collect your co-pay/co-insurance/deductible instead of billing you?
It is the policy of Active Brace and Limb to collect co-pays, co-insurance, and deductibles at the time of service. It has proven to be more efficient for both parties. Otherwise, it becomes more difficult and expensive administratively. Unfortunately, higher administrative costs ultimately result in higher medical costs for the patient.
It is the policy of Active Brace and Limb to collect co-pays, co-insurance, and deductibles at the time of service. It has proven to be more efficient for both parties. Otherwise, it becomes more difficult and expensive administratively. Unfortunately, higher administrative costs ultimately result in higher medical costs for the patient.
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What do we mean when we say something is "covered"?
Covered simply means that an insurance company will pay (in part or in full) for an item, dependent on deductible, co-pays and co-insurance. For example, if you received a knee brace from us that is covered, but you still have not met your required deductible, you would be responsible for the allowed cost of the brace up to the amount of your deductible and any co-pays or co-insurance past that point. Your insurance company will not pay for anything until your deductible is met. If you receive a device or service that is not a covered benefit, you will be responsible for the UCR (usual, customary and reasonable) charge amount. What is a "co-pay"? A co-pay is a flat dollar amount that you usually pay for a service such as an office visit. |
What is the "allowed" amount?
The allowed amount is the fixed dollar amount that your insurance company will pay for a particular covered item or service. The health insurance companies sign contracts with medical providers to be part of their plan's network. By being in network the provider agrees to accept the "allowed amount" as full payment for their services. If a provider is out of network, they will usually use the UCR (usual, customary and reasonable charges) amount. "In Network vs. Out of Network" In network means that the provider and the insurance company have a contract where the provider agrees to accept the amount that the insurance company will pay for a service or device. Out of network means that a provider and the insurance company do not have a contract. The amount that the patient pays is usually higher for out of network providers. |
What is a "deductible"?
Before the insurance company is responsible for any charges, the patient must meet their deductible. A deductible is the amount of money that the patient will be responsible for, out of pocket, when they receive a covered service or device. The average deductible ranges from $100-$2000 and is due each calendar year. The 2014 Medicare deductible is $147, which must be met at the beginning of each year. What is "co-insurance"? Co-insurance is the split of charges after the deductible has been met. Usually they are stated as 80/20, 70/30, or 50/50. The first number is the percentage your insurance company will pay for, and the second number is the patient's co-insurance. |
