Discussion Post

Write a 175- to 265-word response to the following:

  • What is the difference between co-pay and co-insurance? How will knowing these differences help you with billing and coding functions? Provide details and example

Two responses : 


  1.  The biggest takeaway I took from my research was that copay can be defined as the set amount you pay per doctors visit, perceptions, and other medical needs. For example, many plans start out at a standard $10 and up for doctors visits but increase with specialists and ER visits. This is a nice option because you know what you will pay every time you use a specific medical service. But on the other hand, coinsurance can be defined as the percentage of costs you pay after you’ve met the set deductible made clear to you by your health insurance. So for example, if you have a plan that 70% your insurance covers, you must cover the remaining 30% out of pocket. Although it may seem like a deal, you have to be careful. Things that the plan does not cover, you have to pay 100% yourself. Many run into this with certain medications… Medications can be costly, especially if your insurance does not cover it. So all in all there’s benefits and down sides to both plans. Me personally, I’ve only had experience with copays.
  2. Hello Professor, and class a co-pay is a set amount that an individual will pay when they go to their PCP for their medications, office visits, and other type of services . This could include but not limited to a $15.00 co-pay to a $150.00 dollar deductible. Co- insurance is a amount the individual pay after they’ve paid their deductible. The difference between the two is with co- insurance the health care provider insurance will pay up to 70 or 90% of the bill after they pay their deductible and with co-pay the individual is still responsible for 10-30% of the bill after they pay their co-pay. It is important for the staff to determine which type of insurance the patient has in order to correctly bill the insurance company for filing a claim and completing it accurately. When it comes down to billing and coding everything must be put into the data system properly ,else there will be several errors and a lot of delayed payments.