Co-pay – A small amount you pay to the doctor at the time of a visit. Insurance covers the rest.
Deductible – An amount of money you have to pay out of pocket before the insurance company will start covering any of your costs.
In-network – A doctor or facility that has an agreement with your insurance company and is covered as part of your plan.
Out-of-network – A doctor or facility that does not have an agreement with your insurance company. Some plans cover out-of-network costs, some don’t. When they do, they usually cover less of the cost.
Out-of-pocket costs – Costs that you pay for health care that aren’t reimbursed by the insurance company.
Provider – A doctor, hospital or other facility that provides health care.
Reimbursement – You pay all the costs up front, then submit receipts to be paid back (reimbursed) to you by insurance or your placement. The money payed back to you is called your reimbursement.
Sliding-scale – Some healthcare providers charge fees based on your ability to pay. This is called paying ‘on a sliding-scale.’ You generally need to provide an income statement, such as a bank statement or a pay stub, to pay on a sliding scale.
Summary of Benefits – A document from your insurance company that tells you who, what and how much is covered under your plan. This is your guide – read it carefully!