What are deductibles, co‐payments, and co‐insurance amounts?
A deductible is the initial amount that you must pay before your insurance plan begins to pay for your bills. Typically, a deductible is a flat dollar amount.
A co‐payment is a flat amount paid for each visit to a provider. If you have a $50 hospital co‐payment, you must pay $50 for each visit and your insurance company will pay for the remaining balance on all covered services. Co‐pays may vary depending on the location of the visit (i.e. urgent care, emergency department, outpatient hospital clinic, and/or facility).
Co‐insurance is the percentage of the total cost of the health service that you must pay until you have reached your out‐of‐pocket maximum for a certain period of time. Co‐insurance rates vary, but the most common is 20 percent. After you meet your out‐of‐pocket maximum for that period of time, then most plans will pay 100 percent of the allowed amount.
In some instances, you may be responsible for a co‐payment, deductible, and co‐insurance amount during the same visit. Please check with your health insurance plan if you have questions.
Do I have to make a payment before I receive services?
It is our policy to collect the amount that the patient is responsible for prior to or at the time of service. You may discuss payment options when you arrive for your visit, or by phone with a financial care counselor, if you are called prior to your visit.
I had a visit last week ‐‐ why didn’t I get a call before that visit?
Currently, our financial counselors are only providing estimates before treatment to patients who are receiving certain services and may experience higher out of pocket expenses.
You may receive a call if you have a visit in the following service areas at Duke Clinic, Duke University Hospital, or Duke Regional Hospital: radiology, outpatient surgery, ambulatory surgery center, admissions, cardiac catherization, cardiac diagnostic unit, or GI procedures.
How do I know that the amount you estimated is the correct amount?
We are providing you with an estimate of how much you will owe after insurance. Insurance contracts vary depending on allowed services, co‐payment amounts, deductibles, and co‐insurance. Therefore, it is impossible for us to know exactly how much your insurance company will pay or how much you will have to pay.
Please remember that the amount we provide you is only our best guess of what you will after insurance. You will receive a bill that includes your actual charges, insurance payments, and what you actually owe.
If I get a bill or statement after I pay for my future visit, who can I contact with questions about my statement?
Customer service representatives are available to help you. Please call us at 800‐782‐6945 with any questions or concerns you may have about your bill.