Billing Terms You Should Know
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Co-pay
Co-pay
A co-pay is a set fee your insurance company requires you to pay for medical visits, typically ranging from $10 to $50. WHA is considered a specialist practice, but some insurance plans charge only a primary care co-pay for visits like women’s wellness exams. If you pay a primary care co-pay when a specialist co-pay is required, you may receive a bill for the difference.
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Co-insurance
Co-insurance
Co-insurance is the percentage of a medical bill you pay after meeting your deductible. This continues until you reach your plan’s out-of-pocket maximum. The exact amount depends on your insurance plan. If you have questions about what your insurance covers and why, contact your insurer. If you have questions about your bill from us, WHA’s financial counselors are happy to help.
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Deductible
Deductible
A deductible is the amount you must pay out-of-pocket before your insurance starts covering costs. Even after meeting your deductible, you may still owe a portion of your bill due to co-insurance or other cost-sharing rules. If you have questions about how your deductible applies to your care, your insurance company can provide a detailed explanation.
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Out-of-network
Out-of-network
If a provider or service is out-of-network, it means they don’t have a contract with your insurance company. This can lead to higher out-of-pocket costs or unexpected bills. Before your visit, it’s a good idea to check with your insurance plan to understand coverage and ask our office if we’re in-network.
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Balance billing
Balance billing
Balance billing happens when an out-of-network provider bills you for the difference between what your insurance pays and the total service cost. This charge is often higher than in-network costs and may not count toward your out-of-pocket limit.
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Surprise billing
Surprise billing
Surprise billing is an unexpected balance bill. It usually happens when you unknowingly receive care from an out-of-network provider—often at a hospital or during an emergency—and are billed for the difference between what your insurance covers and what the provider charges. In these situations, you are protected against surprise billing.