Question

During this role- play, Michael Smith is meeting with you regarding the bill he receive in the mail. when he called to make the appointment, he was very concerned because he just was laid off and isn't sure how he will pay the bill. You check his record and see that he met his deductible and now needs to pay 30% of the billed amount. he owes $210.

as a medical assistant explain how deductible works

Answer 1

First of all, I will ask Mr Smith to calm down and have a seat. Then I will ask him if he would like a glass of water. I will ask him to provide me with his insurance file so that I can have a look and explain in detail.

Now, as a medical assisstant I will tell him that deductible is a specific minimum amount that is present in almost all of the healthcare insurance and must be paid out of pocket by the person. This amount varies with different policies like one person can have a deductible of $500 while other can have a deductible of $1000. It depends on the insurance company and insurance plan. Once the deductible amount is met by the person, then only the insurance company starts paying for their treatment. But, one thing to be noted here is that it is not 100% necessary that company will pay 100% bill of the person after their deductibles are met. Some plans have separate deductibles for certain services like prescription drug or certain clinic visits. In that case, the person have to met this deductible of prescription drug seperately. In the case of Mr Michael Smith, he has met his deductible and still needs to pay 30% of the billed amount and owns $210. This seems like a case of Coinsurance. Now, the question is,'What is Coinsurance?'

Coinsurance is nothing but a shared amount that a person has to pay along with the insurance company for their treatment after their deductible is met. In Mr Smith's case, it is 30%. It means from now onwards after he has met his deductible, he is suppose to pay 30% of his bill as a coinsurance and the rest will be paid by the insurance company for his treatment.