How it Works: If your plan’s deductible is $2,000, you’ll pay 100% of eligible health care expenses until the amount paid totals $2,000. After that, you share the costs with your plan by paying coinsurance.
Why am I being asked to pay my deductible upfront for drug and alcohol treatment services?
The costs of drug and alcohol treatment services will typically exceed your deductible. When that happens, deductibles are collected upfront as a way to ensure the insurance company will pay their portion of the coinsurance.
How it Works: You’ve paid $2,000 in health care expenses and met your plan’s deductible. Now, instead of paying for all the costs associated with the health care service, your insurance plan shares the cost with you.
For example, your plan pays 70% until your Out of Pocket Maximum has been met. The 30% you pay is your coinsurance. The 30% due typically comes in the form of a bill from the service provider at a later date. Patients are required, by their insurance carrier, to pay the coinsurance to the health care provider until the Out of Pocket Maximum has been met.
Dollar amounts paid towards your deductible, coinsurance, and copays count towards your out-of-pocket maximum. Monthly premiums and any amount paid for health care services that aren’t included in your plan’s benefits do not count towards your out-of-pocket maximum.
NOTE: Some health insurance plans do not apply deductible amounts towards the out-of-pocket maximum. This information will be provided to you by Ocean Hills Recovery after verification of your health insurance benefits has been conducted. You may also verify this information by calling your health insurance.
- Payment plans – If you are unable to pay your out-of-pocket maximum up front you may asked to be placed on a payment plan with monthly payments as low as $50/month until the cost of your out-of-pocket maximum is paid in full.
- Sliding Fee Discount Application – Qualified individuals may complete a Sliding Fee Discount Application to be applied towards the Out of Pocket Maximum. This application will not completely negate your financial responsibility to pay the Out of Pocket Maximum but may decrease the amount owed.
There is a section on the form that states, “patient responsibility.” This is your coinsurance amount for the health care services you received. This is not a bill and no further action is required from you. You may receive a separate bill from Ocean Hills Recovery, Inc. requesting you pay your coinsurance. Remember, coinsurance is paid to the health care provider and not to the insurance company.