Insurance Terminology

Deductible: A deductible is the amount of money an insured person pays out of pocket before their insurance policy begins covering covered expenses. 

Copay: A copay, or copayment, is a fixed amount of money that a healthcare beneficiary pays out of pocket for covered medical services. The remaining balance is usually covered by the beneficiary's insurance company.

Coinsurance: Coinsurance is a percentage of a covered health care service cost that an insured person pays after meeting their plan's deductible. It's a way for the insured and their insurance company to share the cost of eligible expenses, which together total 100%. For example, if a plan's allowed amount for a treatment is $100 and the coinsurance is 20%, the insured would pay $20 and the plan would pay the remaining $80. 

Rate: This is the amount the practice sets and bills to insurance. 

Contracted Rate: This is the amount the insurance sets and agrees to pay per session, which is typically a lower amount than the "rate" set by the practice. If a client has not met their deductible/copay/coinsurance, then the client will be responsible for the remaining "contracted rate".