Your health is your most important asset. Safeguarding it with a quality insurance plan can help you lead a long and fulfilling life. Deciphering the intricacies of insurance can be tricky, however, especially since insurers sometimes seem to speak their own language. Here, Susan M. Smith, CCS, CPC, CGSC, Billing Manager of Ozark Surgical Group in Mountain Home, AR, explains one important concept: The difference between copays and coinsurance, two mechanisms that help you share costs with your health insurance company.

Copays are flat fees that you pay for certain health services, like a prescription or a visit to the doctor’s office. In some cases, the copay may take effect only after an annual deductible—a set amount of money spent by you—is met. If you see the words “deductible applies” on a medical bill, this means you will carry full costs for the service provided. Once you hit the set deductible, the reduced flat-flee of your copayment takes effect. Alternatively, you may see the words “deductible is waived” on a medical bill, meaning that the flat-fee copay is in effect—your insurance provider will share the costs of the service provided.

Coinsurance, meanwhile, is percentage-based. Instead of a flat fee, you pay a certain proportion of the costs for services. The insurance company pays the remaining percentage. The division of percentages often varies depending on your insurance plan and the medical care provided—for instance, whether you are getting X-rays versus undergoing a surgical procedure.

The amount of coinsurance also depends on the type of insurance organization. Health Maintenance Organizations (HMOs), for instance usually do not offer coverage for care that is “out of network.” If you visit a doctor who is not in your HMO, you are left paying for care entirely out-of-pocket. Preferred Provider Organizations (PPOs), meanwhile, may cover 80% of fees for an in-network doctor versus only 25% of fees for an out-of-network doctor.

Given the complexities of health insurance, it’s always a good idea to check with any health care provider regarding the plans they accept when making an appointment. The surgeons of Ozark Surgical Group in Mountain Home, AR, are dedicated to helping patients access the general surgery they need, with minimal hassle. For an appointment, call the surgeons directly at (870) 425-9120.