APTA Communication, Stress, Healthcare Systems, And Professional Roles In Physical Therapy Practice Test

What does co-insurance refer to?

Fixed amount per service. A deductible before coverage begins. The entire bill is paid by the insurer. A fixed percentage of the bill paid by the patient.

Correct Answer:

A fixed percentage of the bill paid by the patient.

Explanation:

Co-insurance is the share of costs the patient pays as a percentage of covered expenses after any deductible has been met, with the insurer covering the rest up to the out-of-pocket maximum. For example, with 20% coinsurance on a service billed at $500, you would owe $100 and the insurer would pay $400, continuing this split until you reach your out-of-pocket limit. This differs from paying a fixed amount per service (a copayment) or from having to pay everything until hitting a deductible, and it’s also different from the insurer paying the entire bill. So the defining idea is that you pay a fixed percentage of the bill.

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