Insurance
There are many questions and misconceptions about medical insurance coverage and terminology, especially as the industry keeps evolving. In the past, you might have paid your premiums through your employer with a small co-payment of $5 or $10, while the insurance covered the remaining costs. Unfortunately, the system has become more complicated. Below, we’ve compiled some useful information to help you better understand your insurance coverage.
Our office will bill your insurance company for all services provided to you (office visits, surgeries, procedures, etc.). Reimbursement from your insurance company to our office is based on our contractual agreement and our participation status. Your benefit plan will determine your responsibilities for several types of payments. Included:
Copayment: A set amount you might need to pay to your doctor during the visit. You could be responsible for a copayment for each appointment, depending on the type of service.
Deductible: The amount you pay out-of-pocket for medical services before your insurance begins coverage each plan year. Some insurers have separate deductibles for individuals and families that must be met before insurance benefits apply.
Coinsurance: After your deductible has been satisfied, your insurance company will pay a percentage of the eligible amount of service charges. You could be responsible for the remaining percentage of expenses beyond the deductible (up to a maximum). The percentage is determined by your benefit plan structure with your insurance company.
The terms under which insurance policies establish these limitations on reimbursement vary widely among policies and depend on your individual contract and benefit plan.
As the patient, it is your responsibility to understand your insurance policy and benefits. We strongly encourage you to contact your insurance company to verify your plan benefits (copayments, deductibles, and/or coinsurance). Co-payments, deductibles, coinsurance, and non-covered services are the member’s responsibility and will be collected up front.
It is our office policy to collect your copayment at the time of service when you check in for your appointment. We will also collect a full or partial payment for your office visit, procedure(s), and/or surgery if your deductible and/or coinsurance have not been met, unless other payment arrangements have been approved by our office.
*All of our physicians are also members of the MACIPA network (Mt. Auburn Cambridge Independent Practice Association)*