Patient Financial Terms
Copay is the fixed amount a patient pays at each visit, as specified by their insurance plan. Copays are typically collected at the time of service and do not usually count toward the annual deductible.
Deductible is the amount a patient must pay out-of-pocket each year before their insurance begins paying for covered services. Until the deductible is met, the patient is responsible for the allowed amount of services received.
Coinsurance is the percentage of costs a patient must pay after meeting their deductible. For example, with 80/20 coinsurance, the insurance pays 80% and the patient pays 20% of the allowed amount.
Out-of-Pocket Maximum is the most a patient will pay during a policy period. Once this limit is reached, the insurance pays 100% of covered services for the remainder of the year.
Contractual Adjustment is the difference between what the provider bills and what the insurance allows. Providers who accept assignment must write off this amount and cannot bill the patient for it.