The patient in the ambulatory clinic asks the nurse in the billing office,"Why do I have to pay $10.00 for this visit when I have insurance?" What is the nurse's most appropriate response?

Question

Quizplus · Accepted Answer

Those who have insurance or government-financed insurance bear some of the expenses of healthcare through cost sharing.Typical cost sharing can be in the form of co-pays,deductibles,paying a portion of one's insurance premium,or paying costs above a fixed payment amount.Patients do not always understand cost-sharing methods and may need an explanation at the time of the visit.The best response is for the nurse to explain what a co-payment is.Most facilities have access to the coverage plan and can answer immediate questions until the patient is able to follow up with his or her insurance company.Stating that healthcare is expensive is merely stating the obvious; it may also be perceived as defensive rather than supportive.Co-payments are typically not part of an insurance premium and are only collected at the time of a service.

The Patient in the Ambulatory Clinic Asks the Nurse in the Billing