Understanding your financial responsibilities 

At 360 Vascular Institute, we combine world-class vascular care with the personalized, compassionate approach that healthcare has lost in today’s corporate-driven world. We believe in treating each patient with the care and attention we would offer our own family, ensuring you receive the warmth and respect you deserve.

Our commitment to exceptional care involves advanced technology, skilled professionals, and financial policies that align with your insurance. The charges we collect — such as copays, deductibles, and coinsurance — are part of your agreement with your insurer, NOT additional costs set by us. These payments help us continue providing high-quality care without compromise. Timely payment of your financial responsibility is essential, and any outstanding balances must be resolved before non-emergency care can be provided.

Our goal is to deliver outstanding care in a compassionate setting. This guide helps you understand your financial responsibilities, so you can focus on what matters most — your health. If you have any questions, our billing team is here to assist you.

Healthcare Costs Explained: A Financial Glossary 

Navigating healthcare costs can be confusing. Below is a glossary of common financial terms to help you better understand your medical bills and insurance coverage.

1. Deductible
The amount you must pay out of pocket for covered healthcare services before your insurance begins to pay. For example, if your plan has a $1,000 deductible, you must pay $1,000 in medical expenses BEFORE insurance starts covering the costs.

Example:

Let’s say your deductible is $500. If you go to the doctor and the visit costs $300, you pay all $300 because it’s less than your deductible. Later, if you go back and your second visit costs $800, you’ll pay the remaining $200 of your deductible. (You already paid $300, and $300 + $200 = your $500 deductible.) Now that you’ve paid the full $500, your insurance will help pay for the rest of that $800 visit — in this case, $600. From now on, your insurance will help cover future medical costs for the rest of the year. Next year, your deductible will start over.

Car Insurance Example:
Imagine your car insurance policy has a $500 deductible. If you’re in an accident and the repair costs $2,000, you’ll pay the first $500 (the deductible), and your insurance will cover the remaining $1,500. If the repair costs less than $500, you’ll pay the full amount.

2. Copay (Copayment)
A fixed amount you pay for a covered healthcare service, typically at the time of service. Copays are set by your insurance plan and can vary based on the type of service (doctor visit, prescription, etc.).

Example:
If your doctor’s visit requires a $30 copay, you will pay $30 at the time of your visit, and the insurance will pay the rest. If you visit a specialist, the copay might be $50 instead of $30, depending on your plan.

3. Coinsurance
The percentage of costs you share with your insurance AFTER you’ve met your deductible. For example, if your plan has 20% coinsurance, you pay 20% of the covered medical expenses, and your insurance covers the remaining 80%.

Example:
If your medical bill for a procedure is $1,000 and you’ve met your deductible, with a 20% coinsurance, you’ll pay $200 (20% of $1,000), and your insurance will cover the remaining $800.

4. Out-of-Pocket Maximum (OOPM)
The most you will pay for covered services in a year before your insurance covers 100% of the costs. This includes deductibles, copays, and coinsurance but does not include premiums.

Example:
If your OOPM is $5,000, once you’ve spent $5,000 on covered healthcare services in a year, your insurance will cover all additional costs for the rest of the year, regardless of deductibles or coinsurance.

5. Premium
The amount you pay each month for your health insurance coverage. It’s the regular fee you pay to maintain your insurance, separate from any deductibles, copays, or coinsurance.

Example:
If your insurance premium is $200 a month, you pay that amount every month, regardless of whether you use healthcare services. However, you still must pay your deductible and copays when you receive care.

6. Explanation of Benefits (EOB)
A statement from your insurance provider explaining the services provided, how much was covered by the insurance, and how much you might owe.

Example:
If you receive a bill for a medical procedure, your insurance provider will send you an EOB showing the amount they covered and the portion you are responsible for paying. The EOB will also list any applied deductibles and coinsurance.

7. In-Network Provider
A healthcare provider that has contracted with your insurance company to provide services at discounted rates. Choosing in-network providers typically results in lower out-of-pocket costs for you.

Example:
If you see an in-network doctor, your insurance may cover 80% of the costs, and you may only have to pay the remaining 20%. However, if you see an out-of-network doctor, your insurance might only cover 50%, and you’ll have to pay the rest.

8. Out-of-Network Provider
A healthcare provider that does not have a contract with your insurance company. Visiting an out-of-network provider often results in higher out-of-pocket costs.

Example:
If you go to a specialist who is out-of-network, you may have to pay a higher portion of the bill. For instance, if your insurance covers 60% of an out-of-network procedure, you’ll be responsible for the remaining 40%.

9. Prior Authorization (Pre-approval)
Prior Authorization or Pre-approval from your insurance company is required for certain treatments, procedures, or medications. It does not guarantee that your insurance will pay for the treatment, but only confirms that the treatment aligns with their policy. Insurance will decide whether to cover the treatment after it has been provided.

Example:
If you need a specialized test that requires prior authorization, your doctor will request approval from your insurance before proceeding. Even after approval, your insurer may still deny payment, leaving you responsible for the costs.

Prior Authorization Example:
Your insurance approves a surgery after reviewing our request for prior authorization, but later decides not to pay for the surgery after the physician has treated you. This is similar to going to a restaurant and then deciding not to pay after you have eaten at the restaurant.

10. Balance Billing
This occurs when an out-of-network provider bills you for the difference between what your insurance covers and what they charge for services. This often leads to higher costs compared to using an in-network provider.

Example:
If an out-of-network provider charges $1,500 for a service and your insurance covers $1,000, the provider may bill you for the remaining $500. This is an example of balance billing, which can leave you with a higher bill than if you had seen an in-network provider.

Understanding these terms can help you make informed financial decisions about your healthcare. If you have any questions, contact your insurance provider or reach out to our office.