We’ve had a lot of questions from potential patients recently about what to expect on the first day they come into the office, so this blog post is here to lay out what happens during a new patient visit.
PPO - Preferred Provider Organization - An insurance plan that has a network of doctors that allows patients to freely choose which doctors they want to see. This allows greater freedom when making appointments, particularly with specialist doctors. You can even see doctors out of this network, but often times will pay a higher price to do so.
HMO - Health Maintenance Organization - An insurance plan with a “gatekeeper” primary care physician (PCP). Patients must visit their primary care doctors for MOST issues prior to seeing a specialist. Acceptions include emergency care and OB/GYN visits. Your PCP will then refer you to specialists when appropriate. It is unusual to get any coverage from a doctor outside of an HMO network.
Premium - Monthly cost paid by a patient to be a “member” of the insurance plan. Paid regardless of whether or not you have any healthcare fees. This is how insurance companies generate the bulk of their money
Deductible - We tell patients this is like their healthcare Buy-in. A deductible is a dollar amount you must spend in a given plan cycle (usually a calendar year) before the insurance company will start to pay for a portion of your healthcare services.
Out of Pocket Maximum - This is a dollar cap on spending during your insurance plan over the course of plan cycle. Once you reach your out of pocket maximum, the insurance company will pay 100% of all healthcare costs for the remainder of the cycle.
CoPay - A fixed dollar amount that must be paid by a patient at each visit. Usually in the neighborhood of $20-60 in our office, you will pay this each time you have a visit.
CoInsurance - The remaining portion of a healthcare bill you are required to pay once your deductible is met. This is usually described as a percentage. Example: Someone with 20% CoInsurance will pay 20% of the bill, and their insurance company will pay the doctor 80%.
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