Private Insurance
Sample Client Cost Share Calculation
Most insurance policies require a co-insurance and or deductible to be collected from the member. Policies vary widely. Some policies have a cost share amount of 50% and others will cover the equipment at 100%. Once you know what your co-insurance and deductible are for your particular policy, it is easy to determine your cost share. The following includes common insurance terms and examples for a device and accessories order totalling $8,000.00.
Terms: OOP (Out Of Pocket), deductible, co-insurance
Example 1:
Insurance benefits will pay 80%. Member responsible for 20%. Deductible of $1,000.00 has not been met. $0.00 has been paid towards the deductible. Out of pocket maximum is $5,000.00.
Total cost of equipment ordered = $8,000.00 - $1,000.00 (deductible) = $7,000.00 X 80% (insurance benefit) = $5,600.00 (Insurance company payment).
Total cost of equipment ordered = $8,000.00 - $5,600.00 (Insurance company payment) = $2,400.00 (Member co-insurance and deductible / cost share due).