Billing Terminology

 Billing terminology can be confusing. Here are some common definitions.

DEDUCTIBLE:  The amount you owe for health care services before your health insurance or plan begins to pay. For example, if your deductible is $5,000, your plan won’t pay anything until you have personally paid $5,000  for covered health care services subject to the deductible. Most deductibles run on a calendar year but not all. The deductible may not apply to all services, as this can be health insurance plan dependent.


CO –PAY: A fixed amount (for example $150) you pay for a covered health care service upon receipt of the service. The amount can vary by the type of covered health care service received. Many times the amount is depicted on your insurance card. This fee is expected at the time of service so plan to pay this amount when you come to the health care facility and check in.


CO-INSURANCE: Co-insurance is usually expressed in terms of a percentage and it indicates the percent of the health care services payment for which  you are responsible. For example if you have an 80/20 plan it means the insurance will pay for 80% of the cost and you will be expected to pay the remaining 20%. It is important to note, you must first meet your deductible and then the co-insurance takes effect. You will pay the co-insurance percentage amount until you reach the maximum out of pocket amount defined by your insurance plan. 


PATIENT BALANCE: This is the amount of money you will owe after insurance has paid their portion. The patient balance will include any remaining deductible and co-insurance.


EXPLANATION OF BENEFIT: This is frequently referred to as an EOB and is issued by your insurance company after they receive a claim. The information on the EOB depicts what is paid by insurance and what has been passed on to you. The information on the EOB should correlate with your outstanding patient balance statement from the health care facility.