This is important for both you and the client to understand. Your client will need to pay you $100 each session until their deductible is met. Let’s say the allowable amount for sessions is $100. Just like you directly pay the doctor the $60 if you are still meeting your deductible, the client will pay you the full allowable amount for each session until they meet their deductible. We have our private pay rate (the $100), but we accept the insurance rate (the $60). In our private practice, we are the doctor. The doctor is not allowed to charge the additional $40 to make up the difference between his private pay rate and the allowable amount – that’s balance billing which is illegal in many states. You won’t pay the $100, you’ll pay the $60. Let’s say the allowable amount for an office visit is $60. He’s an in-network provider, though, so he’s agreed to accept the rate that the insurance company sets for office visits. Let’s say the dermatologist charges $100 for office visits. This is where the allowable amount comes into play for you. The insurance company isn’t going to pay for those until you’ve met your deductible. Yay! However, if you haven’t met your deductible yet, you’re now going to have two bills: one from the dermatologist, and one from the lab. The dermatologist removes the mole and sends it out for to a lab to get it tested. Let’s say you go to a dermatologist to check out a suspicious mole. Next year it’s a new year, so it’s a new deductible. Once you’ve paid $1000 out of your own pocket, the insurance company will start to pay any other claims for the rest of the year. This means, after paying your monthly premium, you will still need to pay all medical expenses up to $1000. Once you have met your full deductible, your insurance will start paying for medical charges. Other than that, you are paying out of pocket until the deductible is met. Exemptions to this are basic well care, like a yearly exam. It’s the amount you pay out of pocket for medical services before your insurance starts to cover the charges. The deductible is a charge in addition to your premium. This is the monthly fee you pay to have coverage, and it buys you a policy. You pay a monthly premium for your medical insurance. You also need to be prepared to help your client understand the details and your policy around them. The deductibles, copays, and coinsurance significantly impact getting payments from clients and you need to understand them and have a policy in place for them before seeing clients. It is a conversation you need to have with your clients from the moment of intake if they are going to use their insurance.Įven if you think you already understand what these are, do not skip this. You also need to help your client understand them since a shocking number of people don’t know the basics of how their insurance coverage works. If you are going to accept insurance in your private practice, you need to understand what deductibles, copays, and coinsurance are and how they operate if you want to get paid.
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