Frequently Asked Questions

What is a co-payment?  A fixed fee that subscribers to a medical plan must pay, for their use of specific medical service covered by the plan.

What is co-insurance?  This is the amount a patient owes after insurance has been filed. For example: most insurance companies only cover 80%, 85% or 90% of allowed charges and the patient is responsible for the balance.

What is a deductible?  A deductible is the fixed amount you pay out of pocket before a health insurance plan begins to cover health care costs.

What does in-network mean?  In-network refers to health care providers that have agreed to provide services to a health plan’s members at a negotiated rate. Plan members usually pay less when using an in-network provider because the cost to the health plan is lower.

When is a procedure considered cosmetic? Insurance companies rely on physicians to submit claims on procedures that in their opinion are medically necessary. Cosmetic procedures could be but are not limited to-benign moles, skin tags, acne/milia extractions and seborrheic keratosis. Also laser treatments to improve appearance or to treat acne are considered cosmetic.

What is an EOB?  It is an Explanation of Benefits that is mailed to the patient and provider, showing amount billed, amount adjusted off, amount paid (if any) or amount applied to deductible.

Please remember to contact your HR department or insurance company for questions concerning your policy. By understanding your policy better, you are an advocate for yourself!