There are three terms that are important in understanding the amount that one owes at each office visit and procedure performed. The insurance plan that you choose determines if one or all of these financial obligations apply. Please remember that Pediatric & Adolescent Urology Institute DOES NOT choose the terms of your health insurance coverage or the reimbursements.
Deductible is a fixed dollar amount that an individual must pay before the insurance company will begin to pay the costs of health care services. For example, if the deductible is $5,000 then the first $5,000 is paid by the individual before the insurance starts paying for any services.
Co-pay is the fixed amount that an individual must pay for different types of health care services. The individual sometimes owes two deductibles on the same visit if a test is also performed. For example, the individual pays a $25 co-pay for an office visit and a $50 co-pay for each test (ex. ultrasound).
Co-insurance is a percentage of the cost of each health care service that an individual must pay. For example, the insurance company pays 70% of costs incurred while the individual is responsible to pay the remaining 30%.