Understanding Your Insurance Coverage

With the health care landscape changing every day, understanding your insurance coverage can be confusing. We know how difficult it is to understand what services are covered or not covered, and what part of your bill you will be responsible for.

Below you will find some information that we hope helps you understand your insurance coverage. If you have additional questions concerning your insurance coverage, Lawrence General Hospital offers Financial Counselors who can assist you. For more information please refer to our financial assistance page.

What is a Co-Pay or Co-Payment?

An insurance co-pay or co-payment is a flat fee that patients pay for certain health care services. This co-pay is set by the insurance carrier. Some insurance carriers require co-pays for doctor visits, emergency visits, or specialist’s visits. Co-pays are expected to be paid at the time of your visit.

What is a Deductible?

An insurance deductible is the amount a patient needs to pay before their insurance health plan begins to pay for health care services that a patient receives. This deductible is set by the insurance carrier, and is renewed every 12 month period. Deductibles may be met in one visit or it may take several visits depending on the amount of your deductible, however once it’s met, you don’t have to pay it again during the 12 month period.

For example, if your deductible is $1,000 and your bill is $1,500, you as the patient are responsible for paying the deductible of $1,000 before the insurance company pays the remaining $500.00 and any additional health care costs you incur for the remainder of the 12 month period.

What is Co-Insurance?

Co-Insurance is what a patient might have to pay after their deductible has been met. In cases where health plans have co-insurance clauses, the patient may be responsible for a percentage of the total amount owed to the doctor/hospital – this percentage is determined by the insurance health plan.

For example, if your health plan states it has an 80/20 co-insurance clause, it means that after you have met your deductible, your health insurance will pay 80% of the remaining costs, and you are responsible for the other 20%.