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What is a Co-Insurance?
By Al Knight, KnightHope Insurance Services
The
term co-insurance is the percentage of a claim that you pay
after your deductible has been met. A typical PPO plan
might be a 70/30 plan, this means after the deductible is
met the insurance will pay 70% of the claim and the client
pays 30%. A good plan will have a co-insurance maximum
which is your stop loss.
Here is an example of how it
works: Lets say you have a 70/30 plan with a $5000
deductible and a co-insurance maximum of $4500. You are
admitted to a hospital for a surgery or illness and the
bill is $100,000. A good PPO policy will first negotiate
a discount off your bill, lets say they get it reduced to
$80,000. If your insurance paid 70% that would be $56,000
which leaves you with a balance at 30% or $24,000. But,
remember the co-insurance maximum of $4500, this means you
would pay your deductible of $5000 and your co-insurance
maximum of $4500 and be done.
Some policies may require you
to meet your deductible before it will pay claims.
I personally look for a policy that will pay claims first
then let me deal with the remaining portion of the bill.
You may even be able to further negotiate a discount on
your liability with the hospital administrator.
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This site developed by Big Blend Magazine™. copyrighted since 1998. No part of it may be reproduced for any reason, with out written permission from Big Blend Magazine, P.O. Box 867, Green Valley, AZ 85622.Opinions expressed by contributors are not necessarily that of this publication or any of its staff. We reserve the right to edit submittals. All subject matter is intended for general information only and not to be take as personal advice in any matter. Although every effort is made to be accurate, we cannot be held responsible for inaccuracies or plagiarized copy submitted to us by advertisers or contributors.
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