What will this doctor’s visit cost me? A quick guide to common insurance terms

Tis the season for colds, coughs, and a variety of other ailments that have people of all ages questioning whether they need to see a doctor. Unfortunately, even those with health insurance often try to tough it out because they are unsure what an appointment will cost. It’s true — insurance jargon can be confusing, and if you’ve ever been shocked by a large and unanticipated bill for a checkup or medical test, we understand the hesitancy. Knowing the common insurance terms can empower you to get the most out of your policy and avoid unwelcome surprises for years to come.


How much will it cost for me to see a doctor?

This depends — are you sick or are you wanting to schedule an annual checkup, also known as a physical? Most insurance plans cover your annual physical or other forms of preventative care at 100 percent, so if you’re not set up with a primary care physician (PCP), do so now

If you are sick, you can expect to pay something, and that amount will vary based on your Disappointed young woman sit on table at home read bad news eviction notice in paperwork letter, shocked female surprised by unpleasant message warning notification received in paper maildeductible


The amount of money you pay each year before your insurance starts paying their share (co-insurance). You may have no deductible, a low deductible, or a high deductible, based on the plan you chose. Those with high deductibles typically enjoy lower monthly costs; however, these individuals will pay more out of pocket each time they visit a doctor.


Even after you’ve met your deductible, you will still be paying your share for medical care. This is often called co-insurance. If your coinsurance is 20 percent, it means your insurance provider will pay the other 80 percent.

How do I choose a doctor?

Finding a doctor you trust is important. You can browse provider bios, read online reviews, or ask for recommendations from friends and family. Before you book an appointment with a certain doctor or facility, it’s a good idea to find out if they’re “in-network” with your insurance company.

[In Network Providers] 

When a provider is “in network,” it simply means they accept your health insurance plan. You may also find these are referred to as “participating providers.” Going to an out-of-network provider may result in higher out-of-pocket costs or no coverage at all.


What do I owe up front, and what can I expect a bill for?

Co-payments are typically collected at the time of service. This may be all you owe, or you might get an additional bill if the doctor orders any lab work or special tests, such as a strep test or flu test.


The amount of money you can expect to pay when you go to the doctor. Your co-payment amount may vary based on the type of care you are receiving. For example, the co-pay to see your primary care physician will often be less than seeing a specialist.


An Example of Visit Costs

Here is an example of how your deductible, co-insurance, and co-payment may work together. Let’s pretend you made a sick visit to the doctor, and the bill, including a strep test, was $135. Your annual deductible is $700. Your co-payment is $25 and your co-insurance is 80% paid by insurance and 20% paid by you. 

Let’s say you already had one other doctor’s visit this year and paid $85. You have already met $85 of your $700 deductible; however, your insurance will not pay anything for this visit since you haven’t paid $700 in medical expenses for the year yet. 

But pretend it’s later in the year and you have already paid $700 out of your pocket in medical expenses. For the $135 visit, you will owe $25 for your co-payment plus 20% of the remaining $110, which equals $22. So for this visit, you will owe a total of $47. 


How can I be better prepared for medical expenses?

It’s important to prepare for health care costs in times of sickness and health. People of all ages have discovered that HSAs and FSAs are extremely helpful for saving money to go toward medical expenses.


HSA stands for health savings account. This is a special savings account that allows you to put in pre-tax dollars that can be used for a variety of different medical expenses, including doctor bills, medical supplies, dental care, and more.


FSA stands for flexible spending account. If you have one of these through your employer, you can save pre-tax dollars to be used toward out-of-pocket medical expenses. Unlike HSAs, FSA dollars have a limited time for use.


Who can answer my questions?

Insurance companies typically have help-lines to answer specific questions around your policy and coverage, but it’s important to find a doctor’s office that is willing to help as well. LeBauer HealthCare strives to make the financial side of medical care clear and simple. No one should feel hesitant to see a doctor or be worried about unanticipated costs after their appointment. Here at LeBauer, it’s our goal to be as transparent as possible with patients and to assist with making sure expert, trusted care is always readily available. We can help you determine what is covered by insurance, submit pre-approvals if needed, and provide clarity on your co-pay. Our user-friendly billing system makes it easy to see what you owe and pay online. Schedule an appointment today.


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