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By: Suzanne Berman, MD, FAAP & Angelo Peter Giardino, MD, PhD, FAAP All health insurance requires consumers to pay some of the cost of covered health care services. This is called "cost sharing" or "out-of-pocket" costs. Cost sharing varies with different types of health plans, but most will have a copayment, coinsurance or deductible amount. Types of Cost Sharing Arrangements & SituationsHow much is paid by the insurance company, and how much is your responsibility, depends on your plan's cost sharing arrangement:
To add to the complexity, different cost-sharing arrangements may apply depending on different situations:
Children's Preventive ServicesChildren's preventive services, such as well-child checkups and immunizations, may or may not be covered without cost sharing. You should carefully review your plan's benefit description for details. The best time to review a plan is before you sign up with it. Methods of PaymentBefore visiting your child's doctor, check the accepted methods of payment for your out-of-pocket expenses. Options for payment may include cash, check, or credit card. Remember to bring your insurance card with you to each visit. Additional Information:
About Dr. Berman:Suzanne Berman, MD, FAAP, is co-founder and managing partner of Plateau Pediatrics, the first NCQA-certified level 3 patient centered medical home in Tennessee. She serves the American Academy of Pediatrics (AAP) in a variety of roles―including the executive committee of the Section on Administration and Practice Management and the Committee on Child Health Financing. Dr. Berman frequently contributes to AAP projects and publications regarding medical home practice transformation, rural health, coding, data mining, and policymaking. She and her husband have three sons. About Dr. Giardino:Angelo P. Giardino, MD, PhD, MPH, is the Wilma T. Gibson Presidential Professor and Chair of the Department of Pediatrics at the University of Utah's School of Medicine and Chief Medical Officer at Intermountain Primary Children's Hospital in Salt Lake City, Utah. He holds subspecialty certifications in Pediatrics and Child Abuse Pediatrics from the American Board of Pediatrics. He is also a Certified Physician Executive (CPE) within the American Association for Physician Leadership. He completed the Patient Safety Certificate Program from the Quality Colloquium, is certified in medical quality (CMQ) as designated by the American Board of Medical Quality and is a Distinguished Fellow of the American College of Medical Quality. Within the American Academy of Pediatrics, Dr. Giardino is a member of the Committee on Child Health Financing, the Council on Child Abuse and Neglect, and the Council on Children with Disabilities. The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. What is the flat amount that a health insurance beneficiary must pay outThis amount is called a deductible. Remember, plans vary in what they pay. No plan will pay 100 percent of your medical expenses, but some plans will pay more than others. Deductibles are the amount of the covered expenses you must pay each year before your plan starts to reimburse you.
What is the term for the amount of money you must pay before your insurance company will pay on a claim?The amount you pay for covered health care services before your insurance plan starts to pay.
What is the money called that you have to pay before insurance pays their part?Deductible. The portion of covered charges that an insured must pay before the insurance company will consider payment and before coinsurance goes into effect.
Is the amount a member must pay before insurance pays?Deductible. A Deductible is the first part of what you pay for your health care before insurance starts to pay for some of your health care.
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