Understanding Insurance & Billing

Insurance & billing can be hard for anyone to understand. We have an amazing billing department here at Texas Sinus & Snoring. We do everything we can to make this part of your journey to health and healing as simple and easy to understand as possible. We're always here to answer any questions. In the mean time we hope this part of our site helps you understand some terms you may hear while in our office and meeting with our patient care coordinator.

What is a Deductible

When you signed up for your health insurance, its likely that you chose a plan based on coverage and a deductible. Your insurance deductible is a contracted, set amount you must pay each year before your health insurance covers the cost of your medical care.

In theory this sounds simple, however not everything you pay for in your healthcare actually count towards your deductible. Often times copays, such as for an office visit, do not count towards your deductible. Every insurance plan is different, which is why its important to review your individual plan and understand your coverage and benefits.

What is a Copay

Copay is short for copayment. Its the contracted rate you will pay for certain medical services. The flat rate you pay for a general practitioner doctors office visit is a copay. The flat rate you pay for a specialists visit, is usually higher than a general practitioner visit, but it is a flat contracted copay rate. While you take care of and pay your copay, your insurance company covers the difference.

It’s important to note that paying a copay for a visit does not always mean that’s all you pay for a visit. The tests run during that visit are sometimes subject to additional payments. Blood work for example at general practitioner’s office. A CT or scope at a specialists office is also a good example. Your insurance usually has a negotiated rate of what you will owe for these services and what they will pay. This is all broken out on your EOB.

What is an EOB

An EOB, or explanation of benefits, is a statement your health insurance company provides to help you understand what part of a service they covered and what part of the service fee you owe. Your EOB will also show how much you paid for a service that will go towards your deductible.

What is Coinsurance

Coinsurance is what kicks in AFTER you’ve met your deductible. This is your contracted rate with the insurance company of what percentage of costs they will cover. Some plans, for example, are an 80/20 Coinsurance. This means after the deductible is met, your insurance will cover 80% of all future covered costs, while you are still responsible for 20%. This remains the case until you reach your out of pocket maximum.

What is Out of Pocket Maximum

This is the most you will have to pay in a year for covered healthcare costs. This can only be met after you’ve met your deductible. Once you’ve hit your out of pocket maximum, your insurance company typically pays 100% of your health care expenses.

How we help at Texas Sinus & Snoring

Insurance & Billing Made Simple - Texas Sinus & Snoring

Our billing department works to help you understand your benefits. We spend a lot of time on the phone getting preauthorizations and making sure billing codes are correct. We know dealing with insurance can be daunting, especially when it comes to surgery. We want to help as best we can.

Our billing department is always here to answer questions about your coverage, preauthorizations or billing. Have a question? Simply call 346-413-9313.