Commonly Used Words Defined

Common Treatment & Insurance Terminology

Coinsurance:

The term coinsurance refers to the percentage of cost you pay for your care after you’ve met your deductible. Percentages vary, with most plans offering 10, 20, or 30 percent coinsurance.

Copay:

A copay is the fixed amount you pay for a service after you’ve reached your deductible. Copays can vary for different services within the same plan, but generally plans with higher monthly premiums have the lowest overall copays.

Deductible:

Your deductible is the dollar amount your insurance company requires that you pay out of pocket each year before your health insurance plan starts to pay for claims.

In network:

An in network facility is part of a health plan’s network of providers with which means the facility and the insurance provider have pre-determined agreed upon rates.

Out of network:

Services that are provided outside a health insurance company’s network of preferred providers are referred to as out of network. The insurance company may not pay for these services or have a reduced payment.

Out of pocket maximum:

Your out of pocket maximum is the most money you’ll need to pay toward the cost of your health care each year.  When you’ve paid enough deductibles, copays, and coinsurance payments to reach the out of pocket maximum, the insurance company pays 100% towards medically necessary treatment until the remainder of the year.

Private pay:

The term private pay is used to refer to someone who doesn’t have insurance that covers a specific treatment and is paying on their own for the cost of care. Private pay is sometimes referred to as self-payment.  Florida Springs Wellness and Recovery Center offers affordable private pay rates and can provide information regarding healthcare loans through outside resources.