How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
A new question is answered every 9 seconds
Ask a Legal question
Type Your Legal Question Here...
characters left:
21 Lawyers are Online Now

Coinsurance Questions

Coinsurance is a type of insurance related term that is used to describe a splitting or spreading of risk across many parties. When it comes to coinsurance, generally, this is a type of penalty that is imposed by an insurance carrier on the party who is uninsured and who under reports, under declares, or underinsures their property. Typically, the penalty is based on a percentage stated in the policy. Coinsurance can give rise to many complex questions that can go unanswered. Listed below are a few questions answered by the Experts on coinsurance related issues. .

A person has a policy of $6,000 with an 80% coinsurance agreement. The insured property is worth $10,000, the loss is $800 and the policy has a $500 deductible. In this case, what would be the amount that the insured would collect?

Based on this, the deductible would come off the top and the insured would probably get 80% of the $300 that would amount to $240.

An individual who has insurance was told by their speech therapist that the cost of the therapy would be covered by the insurance. Now the insurance company refuses to cover the costs and the speech therapist is demanding the money. The individual has agreed to pay the coinsurance due. What else can the individual do now?

If the individual can provide proof that they were told that the therapy would be covered, typically, the individual would not have to pay anything other than the co-payments they would have made had the insurance covered the therapy. This would only be the case if the individual did not sign any agreement stating that they would be personally liable for any and all charges regardless of any insurance. In most cases, a doctor’s office will have a patient sign an agreement saying that they will submit the costs to the insurance company but the patient will be responsible for any and all charges that the insurance does not cover. If there is no such agreement in place and the individual has proof stating that the insurance would pay the therapy costs, they may have a strong case.

Under parity law, how can disability insurance pay for disabled people due to addictions?

The Federal Mental Health Parity and Addiction Equity Act of 2008 requires that group health plans of 50 or more employees that generally provide the equal coverage for both medical and surgical benefits as well as the mental health and addictions benefits. This type of coverage includes deductibles, out of pocket expenses, copayments, and any other out of pocket expenses that the person may have.

Can an out of network physician legally wave or reduce the deductible or coinsurance fee for a patient using his/her health insurance in order to make it more financially feasible for the patient to acquire care?

In most cases, if a physician agrees to an individual price for services that are performed for a patient, they have to report the reduced cost to the insurance company and not a higher one.

Coinsurance helps a person to pay their insurance charges but will penalize the provider if they do not report the splitting of costs. There are several rules and laws governing coinsurance. If you have more questions, put them to an Expert now for insights and answers that can help you deal with your case in the best manner possible.
Ask a Legal question
Type Your Legal Question Here...
characters left:
21 Lawyers are Online Now

How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help. Mary C. Freshfield, Liverpool, UK
< Last | Next >
  • Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help. Mary C. Freshfield, Liverpool, UK
  • This expert is wonderful. They truly know what they are talking about, and they actually care about you. They really helped put my nerves at ease. Thank you so much!!!! Alex Los Angeles, CA
  • Thank you for all your help. It is nice to know that this service is here for people like myself, who need answers fast and are not sure who to consult. GP Hesperia, CA
  • I couldn't be more satisfied! This is the site I will always come to when I need a second opinion. Justin Kernersville, NC
  • Just let me say that this encounter has been entirely professional and most helpful. I liked that I could ask additional questions and get answered in a very short turn around. Esther Woodstock, NY
  • Thank you so much for taking your time and knowledge to support my concerns. Not only did you answer my questions, you even took it a step further with replying with more pertinent information I needed to know. Robin Elkton, Maryland
  • He answered my question promptly and gave me accurate, detailed information. If all of your experts are half as good, you have a great thing going here. Diane Dallas, TX
 
 
 

Meet The Experts:

 
 
 
  • Ron

    ASE Certified Technician

    Satisfied Customers:

    21171
    23 years with Ford specializing in drivability and electrical and AC. Ford certs and ASE Certs
< Last | Next >
  • http://ww2.justanswer.com/uploads/FO/fordguy4u/2011-12-17_222940_HPIM1257.64x64.JPG Ron's Avatar

    Ron

    ASE Certified Technician

    Satisfied Customers:

    21171
    23 years with Ford specializing in drivability and electrical and AC. Ford certs and ASE Certs
  • http://ww2.justanswer.com/uploads/lyeung1/2010-07-25_032152_tn_IMG_0241.JPG Dr. Y.'s Avatar

    Dr. Y.

    Urologist

    Satisfied Customers:

    18385
    I am fellowship trained specializing in general urology and reconstructive urology.
  • http://ww2.justanswer.com/uploads/docjohn174/2008-12-13_170143_johnask.jpg John's Avatar

    John

    Home Appliance Technician

    Satisfied Customers:

    13453
    Appliance repair business owner for over 43 years.
  • http://ww2.justanswer.com/uploads/MU/multistatelaw/2011-11-27_173951_Tinaglamourshotworkglow102011.64x64.jpg Tina's Avatar

    Tina

    Lawyer

    Satisfied Customers:

    8485
    JD, BBA Over 25 years legal and business experience.
  • http://ww2.justanswer.com/uploads/dermdoc19/2010-09-30_160749_Photo_122807_015.JPG dermdoc19's Avatar

    dermdoc19

    Dermatologist

    Satisfied Customers:

    3846
    30 years practice in general and cosmetic dermatology
  • http://ww2.justanswer.com/uploads/BI/birddoctor/2012-6-22_173214_birddoctor.64x64.png Dr. Pat's Avatar

    Dr. Pat

    Bird Veterinarian

    Satisfied Customers:

    3384
    25+ years working primarily or exclusively with birds
  • http://ww2.justanswer.com/uploads/RY/rydergar/2012-6-6_192240_IMG0328.64x64.JPG Dr. Gary's Avatar

    Dr. Gary

    Cat Veterinarian

    Satisfied Customers:

    3297
    DVM, Emergency Veterinarian, BS (Physiology)
 
 
 

Recent Coinsurance Questions

  • I am a non custodial parent. I provide primary health insurance

    I am a non custodial parent. I provide primary health insurance for my child. I am required to pay 48% of extra ordinate costs I.e. what insurance did not cover. Mother bills me these costs then I pay. She then bills coinsurance for the full amount that was not covered by the primary insurance. She ends up making money off the whole process. Is this lagitement and legal. Seems fraudulent and not the intent of the court ordered financial agreement. The court order simply states the father shall pay 48% of the extraordinary medical costs. Shouldn't this mean what is left over after all insurances cover.... primary and co. Some of the extraordinary cost are several thousand dollars so she makes a lot of money through the process and from my daughters ambiguous medical issues. Thanks -Tim
  • I live in TN and have a question about health insurance. I

    I live in TN and have a question about health insurance. I provide Cigna medical insurance for my family thru my employer. Our daughter (who turned 18 Aug/2012) moved out of our home in January. We have had no contact with her since that time and provided no assistance to her but she is still on our insurance plan. This month she has incurred several medical bills, obviously with copays due the providers (such as deductibles and coinsurance amounts). I was not aware of this until I received the EOB statements from my insurance company. Although we have no contact with her I would like to keep her on my insurance after this year, but ONLY if we (her parents) are not responsible for any co-pays. Cigna tells me that because she is 18 that the providers should bill her directly and that we are not responsible even though it is our health insurance plan, but told us to check with an attorney to be sure. Is this correct?
  • We had received an estimate from our dentist for $275. We relied

    We had received an estimate from our dentist for $275. We relied upon the estimate and husband had the work performed during the 6 months the estimate was valid. After dental insurance paid their portion, we received bill for the remaining $642. The work had been performed as planned. We discovered the dentist's office had never contacted our dental insurance provider to ask about our dental plan coverage including materials limitations. The office says they weren't required to check into how our dental insurance plan actually applies, but they said they could have requested preapproval from the insurer but they chose not to. And upon closer inspection, we noticed their estimate had been calculated based on ridiculous coinsurance percentages such as 76% for a crown. Most plans, including ours, pay only 50%. I've discussed it with them twice but they expect us to pay the $642. At the bottom of the estimate in very, very small print is states "Disclaimer: ESTIMATE ONLY! Patient is responsible for all treatment NOT covered by insurance." Well, this is always the case. I don't think this statement should cause us to responsible for the amounts that exceed the dentist's office's recklessly issued erroneous estimate. Given that no additional work or materials had been required when services were rendered, I wouldn't have expected the estimate to have been off at all. Please advise. Thank you. Marsha.
< Last | Next >