Deductible, coinsurance, huh?

May 31, 2018 | Tony Lehrman | @lehrman


When do people learn about how their medical plan works? When they need it of course! Working in Benefits at Mayo Clinic has allowed me a greater understanding of our medical plan. While that is great knowledge to have, that doesn’t mean I’m exempt from many of the same questions patients have about their deductible, coinsurance, and other aspects of the medical plan as my family and I receive services. Case in point: an event we call the “sledding incident” at our house.

Having lived in the Midwest my whole life, sledding is a regular winter activity. A year ago, while sledding at the local hill, my then six year old decided to see if he could ramp the snow pile the older kids had made. I ran down the hill after him, but alas, it did not end well. He flew from his sled and broke his leg.

We knew a trip to the emergency room (ER) at Mayo Clinic was in order. We were back home within a few hours having seen the doctor, had x-rays taken, and the leg put in a cast. It was at that point that I really started to think about how the medical plan would work in that situation.

I knew we would have a copayment for the ER visit, which is a fixed amount charged when we walked in the door. From there, we would be responsible for our deductible and coinsurance. Because it occurred late in the year, we had already met part of our deductible (the upfront cost the patient pays before the plan begins to pay). Once we met the rest of our deductible, the coinsurance kicked in, paying 80% of all covered services, leaving us to pay the remaining 20%. In our case, we did not reach the out-of-pocket maximum. If we had, the plan would have paid 100% of covered services for the rest of the year.

We made sure to review the charges and payments, and verified the claims had been processed correctly, and then worked on paying our remaining balance. If we had a question or concern, we’d call Mayo Clinic Health Solutions at 1-800-635-6671.

All’s well that ends well, as our son made a complete recovery and is back to his normal activities, though this past winter Dad made sure to run alongside the sled as it went down the hill, just as a precaution!

Go to HR Connect on the Mayo intranet and search "medical plan" to learn more about the deductible, coinsurance, and other related terminology.

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