Comprehensive Post-COVID Care Now Available! Click here to learn more.

Billing & Insurance

For Appointment, Complaints & Billing Inquiries

What You Need To Know About:
Insurance, Co-Pay, Deductible, Uncovered Services and Lab Tests

Patients may receive a bill after a doctor’s visit for various reasons. Here are some common ones:

Insurance Coverage:

If you have health insurance, the amount you owe for a doctor’s visit depends on your insurance plan’s coverage. You may be responsible for copayments, deductibles, or a percentage of the cost of the visit, depending on your plan. After your insurance processes the claim, you might receive a bill for the portion that you owe.

Copay:

A copay, short for “copayment,” is a fixed amount of money that you, as an insured individual, are required to pay out of pocket for a specific medical service or prescription medication covered by your health insurance plan. Copayments are a form of cost-sharing in healthcare, where you share the expenses with your insurance provider.

For example, if your health insurance plan has a copayment of $20 for a doctor’s office visit, and you visit a healthcare provider, you would be responsible for paying $20 at the time of your appointment. The insurance company would then typically cover the remaining cost of the visit. Copayments are typically specified in your insurance policy and can vary depending on the type of service or medication. They are designed to help you share the costs of healthcare services and encourage responsible utilization of healthcare resources.

Deductible:

A deductible is a specified amount of money that you, as the insured individual, must pay out of pocket for covered healthcare expenses before your health insurance plan starts to contribute or cover a portion of the costs. In other words, it’s the initial financial responsibility you have before your insurance coverage kicks in.

Here’s how it typically works:

  1. You incur a covered medical expense, such as a doctor's visit, prescription medication, or a medical procedure.
  2. You are required to pay the full cost of that service or expense, up to the amount of your deductible.
  3. Once you've paid the full deductible amount, your health insurance plan begins to cover a portion of the costs for covered services, and you are responsible for paying any applicable copayments or coinsurance.

Deductibles can vary widely depending on your specific health insurance plan. Some plans have low deductibles, which means you don’t have to pay much out of pocket before insurance coverage begins, while others have high deductibles, which means you need to cover a significant amount of your healthcare expenses before your insurance starts helping.

Uncovered Services:

Some services or treatments may not be covered by your insurance plan. If your doctor provides services that are not covered, you’ll be responsible for the full cost, and you’ll receive a bill for these uncovered expenses.

Lab Tests:

If lab tests were ordered during the visit that were not covered by your insurance, you may be billed separately for these tests.

Out-of-Network Providers:

If you visited a doctor who is not in-network with your insurance plan, your insurance will not cover the visit. In such cases, you’ll receive a bill for the full cost of the visit. As Provider is not in-network and patient is responsible to get treatment from out of network provider.

Preventive vs. Diagnostic Care:

Insurance plans often cover preventive care (e.g., vaccinations, screenings) differently from diagnostic care (e.g., tests to diagnose an illness). Depending on the nature of your visit, you may be responsible for costs related to diagnostic procedures.

Additional Services or Tests:

If additional services or tests were performed during the visit that were not initially planned or covered by your insurance, you may be billed separately for these services.

To understand why you received a bill after a doctor’s visit, carefully review the bill, your insurance explanation of benefits (EOB), and communicate with both the healthcare provider’s billing department and your insurance company if you have questions or concerns. They can provide specific information about the charges and help you navigate any discrepancies or issues with the billing process.

In summary, a copay is a fixed fee you pay per visit or service, co-insurance is the percentage of costs you
share with your insurance company after reaching your deductible, and a deductible is the initial amount you pay before your insurance coverage starts. These terms help determine how much you pay for medical care and how costs are split between you and your insurance provider.

Insurances Accepted
at Manhattan Medical Arts

1199benefit

Aetna

American Republic Insurance Company

Caterpillar

Cigna

Consolidated Health Plans

Empire Blue Cross Blue Shield

First Health (Coventry Health Care)

Harvard Pilgrim Health Care

Health Net

HealthFirst (NY)

Humana

MagnaCare

Medicare

Oxford (UnitedHealthcare)

UnitedHealthOne

UnitedHealthcare

UnitedHealthcare Oxford

image

Still looking for something?
Request a Call-Back

    Latest Blog Posts

    Helping You Reach The Best Of You

    • June 21st, 2024

      How Long Does It Take For Hemorrhoids To Go Away?

      Learn more

    • June 19th, 2024

      How To Drain Sinuses? – Tips for Instant Relief

      Learn more

    • June 17th, 2024

      What Causes Veins To Be More Visible in Hands?

      Learn more