I want to know how the co-insurance works? Is similar to a deductible, except that it is a percentage (20%) of the first $5000 costs, and it only applies if I use a hospital outside of their PPO network of hospitals, is that correct? Sounds to me like the deductible is $1250 rather than $250 in that situation.
Do you have information about their PPO network, do they have hospitals throughout US?
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Yes. The 20% co-insurance depends on the insurance plan you purchase. In some plans, there is a 10% Co-insurance and in some others there is a 20% co-insurance. In some plans the entire 20% co-insurance is waived if you use a facility within the PPO network, and is charged only when you use a facility that is outside the PPO network. Details of the co-insurance can be reviewed by using our quote comparison tool.
This is applicable for the first $5,000 of the expense incurred by you.
For Example: If you incur an expense of $3,000, this is how the co-insurance and deductible apply:
Expense = $3,000
Deductible(This is the amount that you pay) = $250
Final Expense amount that the Insurance Company will pay = $3,000 - $250 = $2,750. Now, the 20% co- insurance will be applied on $2,750 when you receive treatment outside of PPO. So, 20% of $2,750 is 550.
Final expense that Insurance company pays = $2,200
The amount that you pay = $800
The PPO network links for both the plans are as below:
ATLAS AMERICA PROVIDER NETWORK
PATRIOT AMERICA PROVIDER NETWORK
You can also buy Atlas America Insurance
and Patriot America Insurance
Please let us know in case you have any questions
+1 (877) 340 7910Reviewed and Updated : April 2019