Since this person works for the insurance company, she probably won’t function as an advocate, but she can answer your questions or field them to the proper decision-makers. Having a case manager also makes it less likely that your issues will be subject to long delays or simply fall through the cracks.
Co-pays: These are the payments you’re charged for specific services. You may have co-pays for each doctor or hospital visit, for lab visits, for other tests such as scans and X-rays, and for drugs and medications from the pharmacy.
Coinsurance: This is the term for the percentage of costs the patient pays. Many people, for example, have 80/20 plans, where the insurer pays 80 percent and the patient pays 20 percent.
Deductible: A deductible plan is set up so that the patient pays the full cost of all fees until the deductible is met. (The deductible is typically annual and resets each year.) What’s confusing, though, is that some plans are set up so that some medical costs apply toward the deductible and others don’t. If this is your situation, ask the insurance company to tell you exactly which costs count toward the deductible and how they notify you when your deductible is met.
Insurance cap: This is where many cancer patients are caught off guard. Some insurance plans have a cap on total medical costs. Once a patient reaches that limit, the plan will no longer cover any treatment costs. Some caps are annual and reset again the following year; some are “lifetime” caps, and once they’re reached it’s like having no insurance.