Payment Options

This refers to the predetermined allowable limits used by insurance carriers to limit the maximum amount they will pay for a service based on their contract with you. "Allowable" charges are sometimes known as reasonable and customary (R&C) charges.

Authorization is the approval of care, by an insurer or health plan. Your insurer or health plan may require pre-authorization before you're treated.

Coinsurance is a provision that limits an insurer's coverage to a certain percentage, commonly 80 percent. This provision is common among indemnity insurance plans and preferred provider plans. If your insurance includes coinsurance, you'll be responsible for charges beyond those covered by your insurance.

Coordination of benefits is an agreement between your insurers to prevent double payment for your care when more than one plan provides coverage. The agreement determines which insurer has primary responsibility for payment and which has secondary responsibility.

Copayment is the portion of a claim or medical expense that you must pay out of pocket. Copayment is usually a fixed amount.

The share of costs by your insurance that you pay out of pocket. Cost share generally includes deductibles, coinsurance, copayments or similar charges. It does not include premiums, balance billing amounts for non-network providers or the cost of noncovered services.

A deductible is the portion of your health care expenses that you must pay before your insurance applies.