Insurance term
Coinsurance
Definition
Coinsurance is the percentage of a covered procedure's cost that the patient pays after the deductible, with the plan paying the rest.
Why it matters for the front desk
Many plans follow a 100/80/50 pattern: the plan pays 100% for preventive care, 80% for basic services such as fillings, and 50% for major services such as crowns, and the patient pays the rest. Plans don't all classify procedures the same way; one may treat root canals as basic and another as major. Confirming the category for each planned procedure is the only way to give an accurate estimate.
Related reading
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What Actually Happens During Dental Insurance Eligibility Verification
Related terms
- Deductible A deductible is the amount a patient must pay out of pocket each benefit year before the plan starts paying for covered services.
- Annual Maximum The annual maximum is the most a dental plan will pay toward a patient's care in one benefit year.
- UCR (Usual, Customary and Reasonable) UCR is the amount a payer considers a usual, customary and reasonable fee for a procedure in a given area, used to set its allowed amount.