Deductible

• Deductible: It is a fixed amount that the policyholder needs to pay before an insurance company starts making payment for the treatment.
• For example, if a policyholder has a deductible of $2,000.00 and he/she undergoes a treatment that costs $1,500.00. So, when this claim is billed to insurance, it will apply toward the deductible and the policyholder will be paying this amount.
• If the policyholder undergoes for second treatment that costs $1,200.00 then this time insurance will apply $500.00 towards the patient deductible and process the remaining $700.00. When processing $700.00, it can also include patient responsibility as coinsurance or copayment based on the policy contract. The policyholder will be responsible for paying the deductible amount of $500.00.
• The deductible clause can be in terms of visit or dollar amount.
• If it is based on a visit then the policyholder will be responsible for full payment of the treatment cost until it reaches the allowed visit.

For Scenarios related to deductibles click on pdf.