Patient Copays, Deductible, and Coinsurance

Patient Copays, Deductible, and Coinsurance – What’s the Difference?

Healthcare can be a complex industry, and sometimes a patient (and even some new administrative staff) can be a little bit unclear on the various types of payments that clinics and healthcare organizations collect, and how each contributes to the overall coverage in an insurance policy. The following is a brief explainer on the most common three types of payments, how they interrelate, and how clinics can use medical payment processing technology to ensure fast, efficient collection in the most convenient possible ways for their patients.В В 



A copayment, or copay, is a predetermined fixed amount that patients pay every time they seek out any kind of healthcare service. Copays generally vary for different types of care but must be paid upfront or in advance of receiving treatment. As an example, a patient might have a $30 copay for each visit to their primary care physician, but only a $10 or $15 copay for each prescription filled. Conversely, emergency room visits and major procedures will normally carry much higher copays in line with the higher costs of those treatments.В 


Insurance Deductibles:

The deductible is the amount that a patient is responsible for covering out-of-pocket before their insurance policy starts picking up the bills. For instance, insurance coverage with a $2000 deductible would not cover the first $2000 in medical bills, but once the patient exceeded $2000 within a given year, all further costs would be covered by insurance (subject to the coinsurance details of the policy.) Deductibles reset every year, so it’s in a patient’s best interest to have the lowest deductible possible.В 



The coinsurance amount defines what percentage of care is paid by insurance and what percentage is paid out-of-pocket once a patient’s deductible has been met for the year. For instance, a 10% coinsurance would require the patient to cover 10% of all treatment costs beyond their initial deductible. Generally, the insurance company’s chunk of the bills is much larger than the patient’s, and once a patient reaches their yearly out-of-pocket maximum, the coinsurance amount goes to zero and 100% of all costs for the rest of the year are covered by insurance.В 


Copayments, coinsurance amounts, and bills incurred prior to hitting the yearly deductible are all the responsibility of the patient and must be collected by the clinic or healthcare organization. Some costs, like copayments, are often required upfront, but larger amounts are often invoiced manually by mail – a process that can result in delayed payments and delinquent accounts. That makes manual invoicing and traditional payment methods incredibly inefficient and potentially detrimental to a clinic’s cash flow.В 

MedicalCRM solves that problem with its advanced billing and payments suite, designed to make it faster and easier for healthcare organizations to send out digital invoices via email and to collect electronic payments in-clinic, online, and over the phone. By getting invoices out faster, clinics minimize the buffer time between delivering services and receiving payment, and by offering convenient electronic payment solutions, clinics ensure their patients can settle their accounts with maximum convenience.В 

For more information on how MedicalCRM can help make collecting payments easier, schedule a demonstration or start your free trial today.

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