what is an in network insurance deductible?
An in-network deductible is the amount of money you have to pay for covered health care services prior to your insurance company beginning to pay any portion of your medical care.
If a provider is contracted with your insurance company, then you will be able to use your in-network benefits for services provided by that in-network provider.
Insurance companies have contracted rates with in-network providers. These rates are set and the in-network provider can not charge you more or less than the set contracted rates.
For example: You have a medical visit with an in-network provider and the medical visit is coded appropriately for the type of visit it is (well visit, sick visit, etc.). This particular visit on this day is a sick visit. The in-network provider codes the visit as a sick visit and submits it to your insurance in the amount of $400.00. The contracted rate for a sick visit for this in-network provider is $150.00. So, you will only be responsible for $150.00 and not the submitted amount of $400.00. Your insurance processes the claim and deducts the amount owed by you (the contracted rate for the visit) from your benefit amounts (deductible, out of pocket max).
How does this visit effect your deductible?
Let’s say you have an in-network deductible of $2,000.00. Your sick visit that you paid $150.00 for will go towards your deductible and decrease your deductible in the amount of $150.00. Now, your deductible is $1,850.00.
Check back for more blogs about insurance including: out-of-network deductibles, coinsurance, copays, out of pocket maximums, maternity care, Medicaid, Baby care, Birth Center benefits and more.