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Health insurance coverage is a complex field, and I'd like to take a few moments on this video to explain to you some common terms used in health care coverage as well as walking through a specific example of how you might calculate your out-of-pocket patient liability so let's talk about some terms first the insurance is your insurance that you have selected or has been selected for you Aetna anthem Medicare there's a variety of health insurances including all the ACA coverages deductible is the amount you owe either annually or per visit for your coverage that deductible can vary wide widely across your payer plan and could be owed as many times as every time you're an inpatient or is an annual deductible you need to check into your coverage to understand you are deductible liability and how much that is copay is what you owe per visit the most common copay is for doctor's office visit you might owe a 10 or 35 copay every time you come in for a visit coinsurance is a percentage of the allowed amount that you owe for that visit coinsurance is can vary widely, and you really need to understand your particular coinsurance you could owe 10 20 as high as 40 coinsurance for that visit that you're having done and that coinsurance is calculated on the insurance allowed amount the insurance allowed amount isn't the charge it's how much the insurance company has agreed to pay your provider for those services you need to understand what that number is you can usually get that from your insurance company as well as often from your hospital or provider your out-of-pocket max is how much let's think of that catastrophic list hat you could offer the entire year in this example this person has a 3000 individual out-of-pocket max and a 6000 family out-of-pocket max critical numbers to understand all of these before you have your procedure done so let's walk through this specific example and how it's calculated, so this is an MRI let's say of the shoulder and the patient has acme insurance they have a 500 deductible for their individual and 1000 family deductible they've met 200 of their individual deductible and 900 of their family deductible there's no copay for an MRI for this insurance company and their coinsurance is 20 of the allowed amount in this case that's 240 the out-of-pocket max for this plan is 3000 for the individual or 6000 for the entire family, and they've met 200 and 1000 respectively of that for the family so now let's walk through what this person is going to owe for this MRI on this date so on the deductible they're going to owe 100 because the family deductible is closer to being met all they're going to owe for their deductible is 100 on the coinsurance the 20 of the allowed that're going to all 240 dollars so that means for this MRI this patient is going to owe 340 dollars for the services provided on that date of service of course this is an estimate you could come in and have something else done on that data service, or you could...
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