A copayment is an amount that is required at the time of the visit. You may have 2 different ones. Could be a regular MD visit for 10.00 or a Specialist visit for 50.00. After the copayments are paid your insurance should cover 100% of the cost. Provided you have met your yearly deductible. Sometimes your deductible may only apply to other services other than office visits.
A Deductible is an amount that your insurance plan sets yearly. You will have to meet this deductible before your insurance pays for your visits. In some cases, you can go to the doctor with just a copayment depending on your plan benefit.
Coinsurance is an amount based on what the insurance plan you have signed up for. Instead of your insurance paying 100% they may only pick up 80% in which case the patient is responsible for the 20% until you have reached your out-of-pocket amount.
An EOB is an explanation of benefits.
This tells us what your insurance has paid along with what your copayment, deductible or coinsurance balance may be. This also tells us what the patient responsibility will be if any. All the EOB’S go to the client before coming to our office for review and posting to accounts.
The delays with your insurance billing are influenced by various factors. Possible explanations for delays include whether the insurance company denied the billed services and we will have to rebill for payment or the insurance company has been a couple months behind in paying the office.
Re-billing an insurance company may happen if the insurance has denied the claim or they may have paid it incorrectly and we may have to call and get the correct payment or explanation on why there was any discrepancies. This can take sometimes a few months or less before we see corrections.
Some delays in payments from insurance companies to our company for payment could be that they are back logged or there may be some other issues with the billing that they have received. This is not common. But, can happen in some cases.