Co-Pays
Many insurance plans require that you submit a co-pay to the provider. The reason a co-pay is required is to offset the amount your insurance company pays directly to the provider, which is almost always less than the fee he or she charges. There has been much debate about the intent of co-pays and deductibles, and potential negative effects on access to care, especially for low-income families. Conversely, there is a clear indication that making a financial contribution at the time of service may increase motivation and follow-through. Philosophical and ethical considerations aside, the co-pay is a fact of life in the current system.
Alert!
In October of 2007, The American Academy of Child and Adolescent Psychiatry petitioned Congress to override President Bush's veto of H.R. 976, the State Children's Health Insurance Program (S-Chip) act, but the override failed. The veto is a terrible blow to the six million children who depend on S-Chip for basic health care needs.
Deductibles
A deductible is an out-of-pocket cost you must meet before your insurance company begins to pay out benefits. Amounts of deductibles vary, and you may have separate deductibles for in- and out-of-network services. Many families use flexible spending accounts or cafeteria plans to help cover them. These health coverage options are discussed below. Check your plan to see if alternative health care such as massage, chiropractic, acupuncture, or homeopathy, as well as prescription costs can be used to meet your deductible.
Co-Insurance
Co-insurance is similar to a co-pay, but it is usually based on a percentage of the fee your provider charges. Sometimes the rate is based on what is considered “usual and customary practice” in your area. In some cases, the percentage of the co-insurance varies slightly from session to session. You may be asked to pay your co-insurance after your provider has received an explanation of benefits showing the portion you owe.
When and How to Pay
After your deductible has been met, you will likely begin making co-pays or co-insurance payments. Most providers request that you make your co-pay at each session. This decreases billing and accounting costs, and ensures that you aren't left with a large balance at the end of treatment. Larger clinics may be able to set up payment plans or bill your charge account for services. They can also help you track your deductible, and make sure your insurance is billed in a timely fashion.
