Glossary of terms

Below are some common terms you may come across when estimating costs or reading a billing statement.

Price transparency

• Charge – The dollar amount a provider sets for services rendered before negotiating any discounts; the charge can be different from the amount paid.
• Price – The total amount a provider expects to be paid by payers and patients for healthcare services
• Cost – The definition of cost varies by the party incurring the expense:
  • To the patient, cost is the amount payable out of pocket for healthcare services.
  • To the provider, cost is the expense (direct and indirect) incurred to deliver healthcare services to patients.
  • To the insurer, cost is the amount payable to the provider (or reimbursable to the patient) for services rendered.
  • To the employer, cost is the expense related to providing health benefits (premiums or claims paid).

Costs for which you might be responsible

• Deductible – The amount you must pay for medical treatment before your health insurance provider starts to pay. For example, it might be $1,000 per individual or $3,000 per family. In most cases, a new deductible must be reached each year before insurance will begin paying.
• Coinsurance – The part of your bill, often in addition to a copayment, that you must pay. Coinsurance is usually a percentage of the total medical bill.
• Copayment or "copay" – The part of your medical bill you must pay each time you visit the physician. This is a preset fee determined by your health insurance provider.
• Non-covered charges – These are costs for medical treatment that your insurance provider does not pay. It is the patient's responsibility to determine if treatment is covered by their health insurance provider before being billed.