What are out-of-pockets costs that are not covered by major medical plans?
Many major medical plans cover a significant portion of medical expenses, but the insured usually has some expenses they must pay on their own. These expenses usually include co-insurance or co-payment, a cost-sharing method where the provider may pay 80 percent and the insurance 20 percent, for example. Or, there may be a set fee, such as a $10 co-payment for any doctor’s office visit. The insured is also responsible for the deductible, a set limit not covered by the provider that the insured must meet before having their costs covered. In addition to these, providers can exclude any expenses they consider beyond “reasonable and customary charges.” It is up to the provider to decide what counts as reasonable and customary.
