Deductibles, Coinsurances, Oh My!

One of our many goals at Jersey Medical Care is educating our patients on the importance of knowing how your insurance plan works, and how it helps you navigate your health.

The good news is that health insurance is designed to share in the costs of your treatments. This sharing of costs between you and your insurance company is often referred to as “cost share.”

This also means that your insurance usually pays most of the bill, but you will still have some financial responsibility for the treatment you receive in our office. The amount that you pay depends on the kind of plan you have. Usually, the more you pay per month to have insurance, the less you’ll have to pay when you go to the doctor.

In this article, we will review how to understand your plan if you have a deductible and a coinsurance cost share. Because you have a deductible and a coinsurance, the amount due to Jersey Medical Care will not be billed to you before the first appointment, but rather once your insurance has processed our bill and assigned a monetary value they will allow based on our contract with them.

The amount you owe for each visit has a lot of factors, including the provider you are meeting with, the service you are receiving, and the time you spend with your treatment team.

Click here to review a broad video on how health insurance deductibles work.

One way to learn what you would be responsible for is to call your insurance customer service number on the back of your card, and ask them for amounts you would be responsible for under our most common procedure codes which are: 90791, 90792, 99204, 99213, 99214, 90833, 90836.

Here is a list of questions you can expect to ask during your call.

Does my deductible apply to my mental health benefits?

Based on my policy, am I responsible for the coinsurance amount, deductible amount, or both?

What is my Max Out-of-Pocket? (more on this here)

I am seeing a provider at Jersey Medical Care, and here are the codes they may be billing you. Can you please give me an average of what I should be expecting to pay? The codes are provided above.

Our office address is 100 Belchase Drive, Suite 101, Matawan, NJ 07747. We are located on the border of Monmouth and Middlesex counties.

If you write down what your insurance allows for each code, you will have a better understanding of your financial responsibility.

To learn more about your account, please ensure you have access to our Client Portal.

Have questions for our billing team? Email Karen at karen@jerseymedicalcare.com or send us a text to 732-707-4100. Please allow up to 48 business hours for a response.