Understanding Your Insurance
Baffled by premiums, deductibles and out-of-pocket maximums? We know that medical bills and health insurance claims can be confusing.
Watch an overview of how health insurance works.
As part of Ochsner’s continued commitment to improving our price transparency for consumers and empowering patients through better access to price information, we are now offering the following options:
Create Your Self Service Estimate through your MyOchsner account
If you do not have a MyOchsner, sign up online
Select a Facility for Your Personalized Estimate of Charges
Common Insurance Terms
These terms can help you with understanding your out-of-pocket costs for healthcare services that are not covered by your insurance benefits.
- Deductible is the dollar amount you must pay toward your healthcare expenses before your benefits plan begins to pay its share.
- Copay (or Copayment) is the fixed dollar amount of healthcare costs for which you are responsible. This is usually a flat dollar amount based on a particular service.
- Coinsurance is your share of healthcare costs that you are responsible for paying. This is paid after the deductible is met for the year.
- Out-of-Pocket Maximum is the most you will have to pay on your own for your healthcare. This includes your coinsurance and deductible. Afterwards, your insurance company will cover 100% of the covered costs.
How is Insurance Applied to Healthcare Services?
For example, if you have a health plan with a $1000 deductible, 20% coinsurance, and a $6000 out-of-pocket maximum. If you had a $50,000 medical bill, you can expect the following to happen:
- Deductible: Your $1000 deductible is paid first. That leaves $5000 before reaching your out-of-pocket maximum.
- Copay (or Copayment): This is the fixed dollar amount of healthcare costs for which you are responsible. This is usually a flat dollar amount based on a particular service.
- Coinsurance: Based on 20% coinsurance, you pay $1000 for every $4000 paid by your insurance company. For the next $25,000 in covered medical expenses, you pay $5000 and your insurance company pays $20,000.
- Out-of-Pocket Maximum: After you’ve paid your $1000 deductible and $5000 in coinsurance, you’ve reached your $6000 out-of-pocket maximum.
Call us directly at 504-703-2773 or 855-241-9351 if you have any questions about the pricing and billing estimates.
Please note, all billing estimates are based on information provided by a prospective patient and do not include, among other things, any unforeseen complications, additional tests or procedures, and non-hospital related charges, any of which may increase the ultimate cost of the services provided. A final bill for services rendered at Ochsner Health System may differ from the information provided by this website, and Ochsner Health System shall not be liable for any differences.
Click here to view our Patient Financial Responsibility Estimate Policy.