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By: Suzanne Berman, MD, FAAP & Angelo Peter Giardino, MD, PhD, FAAP All health insurance requires consumers to pay some of the cost of covered health care services. This is called "cost sharing" or "out-of-pocket" costs. Cost sharing varies with different types of health plans, but most will have a copayment, coinsurance or deductible amount. Types of Cost Sharing Arrangements & SituationsHow much is paid by the insurance company, and how much is your responsibility, depends on your plan's cost sharing arrangement:
To add to the complexity, different cost-sharing arrangements may apply depending on different situations:
Children's Preventive ServicesChildren's preventive services, such as well-child checkups and immunizations, may or may not be covered without cost sharing. You should carefully review your plan's benefit description for details. The best time to review a plan is before you sign up with it. Methods of PaymentBefore visiting your child's doctor, check the accepted methods of payment for your out-of-pocket expenses. Options for payment may include cash, check, or credit card. Remember to bring your insurance card with you to each visit. Additional Information:
About Dr. Berman:
About Dr. Giardino:
Last Updated9/28/2018SourceCommittee on Child Health Financing (Copyright © 2018 American Academy of Pediatrics) The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Which is the percentage the patient pays for covered services after the deductible has been met and the copayment has been paid?The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible. The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”
How much does insurance pay once deductible is met?It's usually a percentage of the approved medical expense. Once you've met your deductible, you might pay 20% of the cost of the health service or procedure, for instance. Your insurance company would pay the balance.
What does 20% after the deductible mean?Coinsurance is the amount you pay for covered health care after you meet your deductible. This amount is a percentage of the total cost of care—for example, 20%—and your Blue Cross plan covers the rest. Learn more about coinsurance and how to calculate your costs below.
When a patient has health insurance the percentage of covered services that is the responsibility of the patient to pay is known as quizlet?When an insurance company pays 80% of the charges and the patient pays 20%, the patient's portion is called coinsurance. Benefits are a list of what it covered under the healthcare plan. The deductible is the amount that a patient must pay out of pocket each time he or she has an encounter with the provider.
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