[Text on screen:
The Ohio State University Wexner Medical Center
Debra Lowe
Administrative Director
Finance]

Debra Lowe, Administrative Director of Finance: Health insurance coverage is a complex field. And I'd like to take a few moments on this video to explain to you some of the common terms used in healthcare coverage, as well as walking through a specific example of how you might calculate your out-of-pocket patient liability. 

So, let's talk about some of the terms first. Insurance is your insurance that you have selected or has been selected for you. Aetna, Anthem, Medicare. There's a variety of health insurances, including all of the ACA coverages. 

Deductible is the amount you owe either annually or per visit for your coverage. That deductible can vary widely across your payer plan and could be owed as many times as every time you're an inpatient or as an annual deductible. You need to check into your coverage to understand your deductible liability and how much that is.

Co-pay is what you owe per visit. The most common co-pay is for a doctor's office visit. You might owe a $10 or a $35 co-pay every time you come in for a visit. 

Co-insurance is a percentage of the allowed amount that you owe for that visit. Co-insurances can vary widely and you really need to understand your particular co-insurance. You could owe 10%, 20%, as high as 40% co-insurance for that visit that you're having done. And that co-insurance is calculated on the insurance allowed amount. 

The insurance allowed amount isn't the charge. It's how much the insurance company has agreed to pay your provider for those services. You need to understand what that number is. You can usually get that from your insurance company, as well as often from your hospital or provider. 

Your out-of-pocket max is how much, let's think of that catastrophically, that you could owe for the entire year. In this example, this person has a $3,000 individual out-of-pocket max and a $6,000 family out-of-pocket max. Critical numbers to understand all of these before you have your procedure done. 

So, let's walk through this specific example and how it's calculated. So, this is an MRI. An MRI, let's say, of the shoulder and the patient has ACME Insurance. They have a $500 deductible for their individual and a $1,000 family deductible.

They've met $200 of their individual deductible and $900 of their family deductible. There's no co-pay for an MRI for this insurance company, and their co-insurance is 20% of the allowed amount. In this case, that's $240. 

The out-of-pocket max for this plan is $3,000 for the individual or $6,000 for the entire family. And they've met $200 and $1,000 respectively of that for the family. 

So, now let's walk through what this person is going to owe for this MRI on this date. So, on the deductible, they're going to owe $100. Because the family deductible is closer to being met, all they're going to owe for their deductible is $100.

On the co-insurance, the 20% of the allowed, they're going to owe $240. So, that means for this MRI, this patient is going to owe $340 for the services provided on that date of service. 

Of course, this is an estimate. You could come in and have something else done on that date of service, or you could change what you owe on your deductible between now and when your services are provided. 

Do your homework before you have a procedure done. Understand what you are going to owe, what your responsibility is. Go in as an informed consumer and you'll have fewer surprises.

[Text on screen:
The Ohio State University Wexner Medical Center]