What is Co-Insurance?

The amount you are required to pay for medical care in a fee-for-service plan or preferred provider organization (PPO) after you have met your deductible. The coinsurance rate is usually expressed as a percentage of billed charges. For example, if the insurance company pays 80 percent of the claim, you pay 20 percent. ($8000 of a $10,000 hospital bill, while the member is responsible for the remaining 20% or $2,000.)

It is the percentage amount that your insurance requires you to pay to your physician after you have paid your deductible. When you have met your "out-of-pocket" limit specified by your plan, your insurance will then pay 100% of allowed charges.

What is Copay (copayement)?

A cost sharing arrangement in which you pay a specific charge for a specific service. Amount that usually appears on your insurance card. For example, $20 for an office visit or $10 for a prescription. The $10, $15, $20, etc. One amount for primary care, and another is for a specialist (normally higher than primary care). By law, healthcare providers are required to collect copayment from their patients.

What is Deductible?

The amount of money you must pay each year to cover your medical care expenses before your insurance begins to pay for your charges. This amount is in addition to your copay. For example: $100, $250, $500, $1000 etc. To determine your annual deductible, contact your insurance company. By law, healthcare providers are required to collect deductible from their patients.

What is Out-of-pocket Maximum?

The most money you will be required to pay per year for deductibles and coinsurance. It is a stated dollar amount set by the insurance company, in addition to regular premiums.

What is Pre-Authorization?

A cost containment feature of many group medical policies whereby the insured must contact the insurer prior to a hospitalization or surgery and receive authorization for the service.

What is secondary insurance?

Helthcare providers are not required by law to bill secondaries or secondary insurers. It may be required by contract. Please contact us for more details.

Which insurances do you accept?

• Premera Blue Cross
• We are terminating our provider contract with Regence Blue Shield and Blue Cross Blue Shield effective 8/11/2004

If your insurance plan does not participate with us, it is difficult to predict what will be paid. We encourage you to check with your employer, health plan appropriate party about benefits before coming to our clinic. It is important that you know your health plan benefits.