Understanding Your OneHealth Medical Bill or Claim

Receiving a medical bill or claim can be overwhelming, especially when trying to understand the different parts that make up how much you owe. This article aims to help you comprehend the various components of your OneHealth medical bill or claim.

Total Charges:

This is the initial amount billed by the healthcare provider for services rendered. It is essential to note that this is not the amount you will pay out-of-pocket.

Greenshield Discounts:

OneHealth negotiates discounts with in-network providers on your behalf. These discounts reduce the total charges, lowering the overall amount that needs to be paid.

Copayment (Copay):

A copay is a fixed dollar amount you pay for specific services, such as doctor visits or prescription medications. Copays are typically due at the time of service.

Deductible:

Your deductible is the amount you must pay out-of-pocket for covered healthcare services before OneHealth begins to pay. Once you meet your deductible, you will only be responsible for copays or coinsurance for covered services.

Coinsurance:

Coinsurance is your share of the costs of a covered healthcare service, calculated as a percentage of the allowed amount for the service. For example, if your coinsurance is 20%, you will pay 20% of the allowed amount, and OneHealth will pay the remaining 80%.

Amount OneHealth Pays:

This is the portion of the bill that OneHealth covers after applying any discounts, copays, deductibles, and coinsurance.

Amount You Owe:

This is the final amount you are responsible for paying after OneHealth has processed the claim and applied any discounts, copays, deductibles, and coinsurance.

Out-of-Pocket Maximum:

Your out-of-pocket maximum is the most you will pay for covered healthcare services in a plan year, including deductibles, copays, and coinsurance. Once you reach your out-of-pocket maximum, OneHealth will pay 100% of the allowed amount for covered services for the rest of the plan year.

Example Scenario:

Let's break down a sample claim to illustrate how these components work together:

• Total Charges: $1,000
• OneHealth Discounts: $300 (You are left with $700)
• Deductible Remaining: $200 (You pay this amount, leaving $500)
• Coinsurance: 20% (You pay $100, which is 20% of the remaining $500)
• Amount OneHealth Pays: $400 (This is the remaining amount after your coinsurance)
• Amount You Owe: $300 (This is the sum of your deductible and coinsurance payments)