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Commonly Asked Patient Questions

Briefly, co-pay, which is short for copayments, is the amount you must pay for a doctor’s visit (or other healthcare services) under your insurance plan. Copayments can vary for different services within the same plan – such as medications,
laboratory tests, and consultations with specialists. Generally, plans with lower monthly premiums tend to have higher copayments, while those with higher monthly premiums typically feature lower copayments.
As an example – suppose the approved cost for a doctor’s office visit under your health insurance plan is $100, and your co-pay (as per the insurance plan) for such visits is $20. If your deductible has been satisfied, you typically pay $20 at the time of the visit. However, if you have not yet met your deductible, you would pay the full allowable amount of $100 for the visit.
Below are some of the typical medical services that might necessitate a copayment:

  • Consultation with a general practitioner or specialist during an office visit.
  • Urgent care appointments.
  • Emergency room visits.
  • Prescription medications.

Copayment is not a universal feature in health plans. It is crucial to review the documents of your insurance plan to determine whether copayments are mandatory.

The deductible is the sum you contribute towards covered healthcare services before your insurance plan initiates its coverage. For instance, with a $2,000 deductible, you personally cover the initial $2,000 of eligible services. Once your deductible is met, you typically only incur a copayment or coinsurance for covered services, with the remaining expenses being covered by your insurance company.

A health plan with a lower deductible typically comes with a higher monthly premium. While you may have a higher monthly payment, the advantage is that your health plan begins sharing costs sooner, as you reach your deductible more quickly.

HIPAA- stands for Health Insurance Portability and Accountability Act (1996). It was designed to protect the health data privacy of patients. It ensures that sensitive information, which includes:

  1. Electronic health records (EHRs)
  2. Personal identifiable information (PII) and financial
    information are not disclosed without the consent of the patient. HIPAA guidelines apply to Healthcare providers, Healthcare plans, Healthcare clearinghouses and Business

However, there are certain circumstances which allow for patient information to be disclosed prior to patient’s authorization. Click to read more about this on the CDC website – Health Insurance Portability and Accountability Act of 1996 (HIPAA)

A typical patient bill includes date of service, description of services, and cost of service. The cost of services includes different amounts which are –

  • Total charges
  • Allowed amount (the maximum amount your health plan covers for the service)
  • Adjustments (any discounts offered by your provider for the service)
  • Insurance payment (the amount your insurance plan is expected to pay/ or has paid)
  • Patient payment (amounts you have paid)
  • Balance due (amount to be paid by you)

Take the time to scrutinize your bill, paying close attention to the following details:

  • Dates and duration: Verify that the dates on the bill align with your hospital stay. If you are admitted after midnight, ensure charges commence on that day. Upon morning discharge, confirm you aren’t billed for the entire daily room rate.
  • Numeric accuracy: If a charge appears excessively high, ensure there are no extra zeros appended (e.g., 1,500 instead of 150).
  • Avoid double charges: Confirm that you are not billed twice for the same service, medication, or supplies.
  • Medication charges: If you brought medications from home or were prescribed a generic drug, verify that you are not erroneously charged for it.
  • Routine supplies: Challenge charges for common items like gloves, gowns, or sheets, as they should be included in the hospital’s general costs.
  • Test or scan interpretation costs: You should only incur charges once for tests or scans, unless a second opinion is sought.
  • Cancelled services: Check for any tests, procedures, or medications ordered by a provider that were later cancelled to ensure they are not billed.

Being vigilant about these aspects can save you money and contribute to the accuracy of your medical billing. If discrepancies are found, promptly communicate with your healthcare provider or facility to rectify the issues.

Successful payments may take up to three working days to reflect in your patient account. If a payment is not reflected, please check with your bank statement to verify whether the amount was deducted from the bank account. If the money has been deducted and is not reflected in your provider’s bill, please contact us with proof of bank transaction.


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