Maximum Medical Billing Services

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What is....

Copay

Deductible

Coinsurance

Plan Benefit

Non-covered

Discount

Out-of-Pocket

Copay

  1. What is a Copay?

    Means a specified dollar amount that a

    covered person is required to pay for certain

    covered expenses. The patient should pay this

    amount at the time of service.

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Deductible

  1. What is a deductible?

    Means the amount a covered person

    must pay for certain covered expenses in a calendar

    or plan year before insurance will begin paying

    benefits in that calendar year or plan year. Copays do not

    apply toward satisfying the deductible. The patient

    should pay this amount at the time of service.

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Coinsurance

  1. What is Coinsurance?

    Means the amount a covered person

    must pay, calculated using a fixed percentage, for

    certain covered expenses. The patient should pay

    this amount at the time of service.

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Plan Benefit

  1. What is a Plan Benefit?

    Means the amount payable for

    medically necessary treatments, services, and

    supplies that qualify for coverage under your policy.

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Non-covered

  1. What is Non-covered?

    Means expenses not covered or in

    excess of policy benefits. The patient is responsible

    for paying this amount to the health care provider.

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Discount

  1. What is a discount?

    Means the billed amount was reduced

    per an agreement with the health care provider. The

    patient is not responsible for this amount.

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Out-of-Pocket

  1. What is Out-of-Pocket

    Means the amount of the deductible

    and unpaid co-insurance that the covered person or

    their family must pay each calendar/plan year for

    covered expenses.

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