Confusing Alphabet Soup of Health Insurance

PBS just published a good article on the confusion of all of these healthcare terms that continue to invade our daily life. Many people struggle with the alphabet soup of healthcare insurance. I will give you a perspective today on the most commonly used terms and what they mean. For reference, you can find the PBS article at http://www.pbs.org/newshour/rundown/many-new-patients-overwhelmed-health-care-jargon/

  1. HMO
      This stands for Health Maintenance Organization. HMOs are typically the cheapest products on the market. They provide a lower price based on the fact that there are typically incentives to certain physicians and facilities in the network to lower the use of healthcare by the patients who have chosen and HMO as their healthcare plan. These arrangements have a true “gatekeeper” model where nearly everything, from physical therapy to imaging to surgery, must be approved by the primary care physician.
  2. PPO
      This stands for Preferred Provider Organization. PPOs are more expensive and provide the patient with more choice. These are typically arranged without the need to consult with your primary care physician prior to seeing a specialist, getting an MRI, or seeing a therapist. In most cases, there is a preferred network of providers that are available to you “in-network” with a lower deductible and copay. Most still offer “out of network” benefits if you would like to see a doctor who does not participate in or contract with your PPO insurance plan.
  3. Copay
      This is the amount you pay for a given service or item. Typically, we talk about copays with regards to office visits to physicians and buying prescription medications. Copays are generally a set amount, although there is typically tiered pricing. In many plans, insurance companies are shifting to copays for prescription medications only after your deductible has been met.
  4. Deductible
      A deductible is the amount of money you must pay out of pocket before certain insurance benefits become available to you. Sometimes you must meet a deductible for your prescription medications before a copay price is available to you. In most cases, you must meet a deductible before coinsurance is applied. Many insurance plans have different deductibles for “in network” vs “out of network” and different deductibles for each individual vs the family. Meeting the individual deductible does not mean that everyone in your family now only has to pay coinsurance or copays, but if you meet the family deductible, each individual is now eligible for copays or coinsurance regardless of whether or not they met their individual deductible
  5. Coinsurance
      Coinsurance refers to the percentages that the insurance company and the covered patient are each responsible for when a bill arrives. Coinsurance typically starts after a deductible is met. A common coinsurance percentage is 80/20, where the insurance company pays 80% of remaining bill after a deductible is met. Typically, there are different coinsurance amounts for in network and out of network

    Out-of-pocket maximum

      This is the maximum amount one can pay in a given year, including copays, deductibles, and the patient portion of coinsurance

Example:

Joe has insurance through ABC insurance company with a $3000 deductible and 80/20 coinsurance. He has surgery, with bills from the hospital, surgeon, and anesthesiologist that add up to $10,000. Joe will have to pay the first $3000 (assuming he had no other medical bills that year) and then 20% of the remaining amount ($10,000 – $3,000 = $7,000). He therefore owes $3,000 (deductible) plus $1400 ($7,000 * 20%) for a total of $4400. His insurance company will pay $5600 (80% of $7000). If Joe had surgery again later that year, he would immediately be responsible for only 20% of the cost, as he will have met his deductible for the year

Alena H.Alena H.
19:26 26 Mar 24
Lynnette CorkernLynnette Corkern
18:37 26 Mar 24
Great staff. Arrived early and got in early!
Brent RiederBrent Rieder
15:36 22 Mar 24
Despite being a difficult patient, requiring various levels of treatment, Dr. Bruggeman, Kim, and the entire staff were exceptional. For the first time in 7 years I have no sciatica pain. The separate procedure for collapsed cervical spine also has resulted in neck mobility and lack of pain for the first time in ~25 years. The doctor’s follow up attention was always amazing and appropriate. I thoroughly recommend his group without reservation.
Lori BecknellLori Becknell
04:03 22 Mar 24
Great doctor, super intelligent, fabulous bedside manner and best of all amazing surgeon!! Plus great staff!!
vince carbajalvince carbajal
18:34 20 Mar 24
holly henckelholly henckel
17:39 20 Mar 24
Love Dr. Bruggeman and his whole staff. Replaced a disc in my neck. Recovery is not hard at all
Miny MunozMiny Munoz
17:09 14 Mar 24
Vanessa Van DeursenVanessa Van Deursen
15:03 13 Mar 24
Very nice and timely
Jennifer SalasJennifer Salas
23:52 11 Mar 24
Alma HastingsAlma Hastings
19:22 07 Mar 24
Super appreciate that Dr. Bruggeman took time to explain my options and was so helpful in explaining realistic outcomes based on my injuries
Magali MartinMagali Martin
21:57 29 Feb 24
Always pleasant and helpful. Staff is always so friendly and nice. The staff is really great at getting you in an out in such a timely manner.
Joe EscalanteJoe Escalante
21:58 20 Feb 24
Today I saw Yvonne. She was great. Took her time with evaluation. It was a follow-up appointment. Also as always. The front desk receptionists were very nice.
Adrian FloresAdrian Flores
21:44 20 Feb 24
Polo GarciaPolo Garcia
01:19 20 Feb 24
AMELIA ATKINSAMELIA ATKINS
17:02 15 Feb 24
Great experience. Staff took care of my every need. Very pleasant environment.
delia cantudelia cantu
16:30 15 Feb 24
Bridget Ruiz is a great PA they all work together with Dr. Bruggeman. They’ll fix the problem
Earl W JuryEarl W Jury
16:16 15 Feb 24
Alejandra VasquezAlejandra Vasquez
23:11 14 Feb 24
Excellent staff, they take their time with each patient, they make me feel safe and they are always attentive to their patients. Excellent doctors.
Amy HodgesAmy Hodges
20:36 14 Feb 24
SO EFFICIENT and clear Professional experienceAn A plus!
Tempie LyonsTempie Lyons
02:18 14 Feb 24
My back pain was incapacitating. I asked at physical therapy what surgeon they saw the best results from. Following their recommendation, I went to Dr. Bruggerman. I have to agree with the PT. Dr. Bruggerman and his staff are excellent.
J GJ G
01:56 09 Feb 24
A three-star review is “okay” and reflects that I had an “okay” experience.I was uncomfortable from the moment I walked in. Front desk staff was not rude, but they weren’t welcoming either. Looked at me like I must be in the wrong place.The PA I met with was very nice, and she listened, but I still felt a bit rushed. I know she would have answered any questions I had, but I didn’t know enough about my condition to know what to ask. I met with Dr. Bruggeman very briefly, and I do appreciate that he makes the time to even meet with patients at their initial appointments.The lady who handled check-out was by far the nicest staff member. She looks at my paperwork, says “you’re having ALIF?” and I said, I guess so, and then had to go home and Google it because no one, neither the PA nor Bruggeman, told me that I may need to have ALIF or what it was.So, yeah. It wasn’t a bad appointment by any means, but I will not be continuing my care there.
paige thigpenpaige thigpen
16:50 08 Feb 24
Excellent service!! They really care about you here, And the atmosphere is relaxing!
julian felanjulian felan
19:54 07 Feb 24
staff is nice doctors are cool
Carlos BarronCarlos Barron
22:52 05 Feb 24
Angelica TobiasAngelica Tobias
20:19 02 Feb 24
Excellent customer service!
Charity ThomasCharity Thomas
19:16 02 Feb 24
They were very quick and nice
Irma CanalesIrma Canales
22:12 31 Jan 24
Excellent overall service.I had a decompression surgery in 04/23 and an SI fusion surgery in 12/23 both with excellent results. I highly recommend Dr. Adam Bruggeman and his staff.
David ForrestDavid Forrest
17:04 31 Jan 24
Friendly caring staff. Couldn’t ask for better treatment.
Victoria PashVictoria Pash
21:14 26 Jan 24
This practice is wonderful! The office is beautifully appointed and the staff is very friendly. I mean, everyone – the receptionists, the assistant, the provider – was kind and helpful. I’ve never been to a doctor’s office where the staff and the atmosphere were both so welcoming. Thank you!
Rudy HernandezRudy Hernandez
20:39 25 Jan 24
Arturo VelaArturo Vela
20:08 25 Jan 24
Great service all around from staff to the dr really professional and knowledgeable
Erika CazaresErika Cazares
18:51 25 Jan 24
I took my mom to get a consult at Texas Spine Center. Our initial visit was nothing short of excellent. The front desk staff were very nice and courteous and the wait time to get taken to a room was very minimal, not even 5 minutes. Once in a room, we were greeted by NP Paredes and she was such a lovely and nice person. She was very knowledgeable and spoke Spanish, so she was able to communicate fluently with my mom, which was such a huge plus! She evaluated my mom thoroughly and walked us through everything she was doing and knew. Afterwards, she went above and beyond and introduced us to Dr. Adam Bruggerman so we could meet him and know that he’s the one that will be treating my mom.Overall, our experience there was PERFECT. We’re very much looking forward to continue my mom’s treatment there at Texas Spine Center. I just wish we could’ve found this place sooner. Thank you for everything!
Jean GarciaJean Garcia
18:32 25 Jan 24
Danny KimberDanny Kimber
15:11 20 Jan 24
Great staff, very understanding and considerate of your needs and willing to make it work for you and your schedule .
Georgia ArandaGeorgia Aranda
18:03 19 Jan 24
Dr. Bruggeman did a great on my Microdiscectomy. My severe pain went away. And now I am on the recovering stage.His office staff if very friendly, nice and professional.I would recommend Dr. Bruggeman to others people that I think might have the same issue as mine.I am sure he does a great job with other type of back surgeries too.
Damon JDamon J
18:26 18 Jan 24
Dr. B and his staff continue to offer excellent service and caring support throughout your pre op, surgery and recovery process. Kim and Yvonne are both top notch PA’s who aid in the success of this office. Thank you all for the support.
Julian RamonJulian Ramon
16:29 18 Jan 24
Dr. Bruggeman and his PA Kim did a great job at explaining my lumbar spine injuries and a plan for treatment. The office staff were all friendly and efficient.
Excellent service, office staff are professional and friendly
STEPHANIE CRISPINSTEPHANIE CRISPIN
19:50 17 Jan 24
I really like how clean and organize and how the privacy very helpful there office is and also the candies they had out for the clients to take and making sure we got all the help we need
rodney acostarodney acosta
17:49 17 Jan 24
Alex MaertensAlex Maertens
22:26 11 Jan 24
Very professional, accommodated my inability to use their first platform and were flexible with getting me seen. Took the time to listen to my issues and tailored solutions to my unique problem. Would recommend to anyone.
Shawne MaltsbergerShawne Maltsberger
20:11 11 Jan 24
They are very nice and Professional
Eddie VEddie V
21:53 08 Jan 24
I love this place. Dr. Kanz is amazing definitely my favorite number 1 doctor.Great bedside manners, personable, respectful and professional. All staff members are approachable and attentive.
Mark SanchezMark Sanchez
19:44 22 Dec 23
First visit was amazing. The staff friendly and the Doctor was awesome. Told me the options I had and what would work best. I am glad I found them. Looking forward for the help moving forward.
Welma NelsonWelma Nelson
21:22 07 Dec 23
First time visit today and my experience is so wonderful. Dr Yvonne Paredes very awesome Dr. she listen and evaluate how I feel with my neck, upper back and lower back. Very clean office. This office provides quality of work not quantity and that’s the most important to me as patient. I would recommend this office if you are looking for a Spine Doctors.
Carlos GarciaCarlos Garcia
17:51 01 Dec 23
2 yrs ago I hurt my back doing something as simple as getting out of a car. I thought my life was over as I knew it due to the pain I was in and nothing helped. I was referred to Dr Bruggeman .He gave me my options and in less than a month I was scheduled for surgery and I walked out of the hospital the same day of surgery. I was scared and. stayed overnight nearby in case of complications However I experienced no pain at all . I walked out to dinner that night. I did experience a little pain about 2 weeks weeks out but he told me that would happen and was given meds without hesitation for my pain . it lasted about 3 weeks then it got better and better. I returned to work 2 months later and have been pain free since. His staff was always very professional and courteous and helped make my experience a great success. I would recommend this Office in a heart beat.
Beatriz BerryBeatriz Berry
16:04 01 Dec 23
Amazing, caring, staff. They are good at what they do, from procedures to customer service this where you want to go. They are truly a blessing and I highly recommend them!
The MillersThe Millers
18:02 08 Nov 23
Dr Bruggeman and the entire Team are a blessing to our community. The folks at Texas Spine Care Center genuinely care about people! I am 3 months past my back surgery, I am 100% pain free. I have not felt this good for over 20 years!!
Mari MoralesMari Morales
16:33 25 Oct 23
Dr Bruggemann & his Amazing staff treated me with genuine care, respect & in a very Profesional manner. He allowed me to explain my concerns and provided me the best treatment & options for my needs. Truly gave me a sense of “Hope.” If I ever need orthopedic services in the future, HE is my Dr. Of choice. Thank you & God bless.
Leo H.Leo H.
16:07 29 Sep 23
Always a pleasure visiting Dr. Bruggeman’s office. The staff and facility is amazing. Kim Ruiz did such an amazing job of explaining everything in detail with me and she was very patient with me while I asked my questions. I felt safe and comfortable with the course of treatment recommended.
Marie MMarie M
15:01 06 Sep 23
There were friendly and helpful staff. Also, it was an excellent detailed explanation from the nurse practitioners and this doctor, Dr. Bruggeman. They let you decide what you would like to do.
Dianne AldreteDianne Aldrete
18:16 11 Aug 23
This is my 1st time back in 3yrsThe office is beautiful, comfortable and the staff is great as always. The Doctors are absolutely wonderful. You matter there. The care is and has been the very best.
Caliyah ClarkCaliyah Clark
03:52 27 Jul 23
I went to see Dr.Bruggeman for a cervical consultation and it was a very pleasant experience. The office is nicely decorated and organized. Front desk staff was welcoming and polite. Dr.Bruggeman was thorough and very kind! I like the fact that everything was electronic, no need to fill out papers, everything was on IPads. I would definitely recommend to anyone!
Kristi StuckeyKristi Stuckey
16:03 20 Jul 23
The staff at Texas Spine Care Center were wonderful from start to finish. This being my first visit, I arrived early and was helped promptly. The whole process was efficient and pleasant. The atmosphere is calming, almost spa-like. Excellent first impression.
B865123B865123
23:30 19 Jul 23
Has a great experience with Dr Bruggerman. I was referred to him with the thought that I would need back surgery. Dr Bruggerman and his staff talked through options with me which included a chiropractor. After 6-weeks with the chiropractor I no longer need surgery. I’ll still need to continue PT but so much better than the alternative. So nice to know it’s not all about the money but the patients overall well being!
S BryantS Bryant
04:26 11 Jul 23
Oh my goodness, I don’t even know where to start! I first went into this office after having a failed microdiscectomy done by different surgeon in January of this year (2023). I was so scared that I was going to be treated the same as I was at the other center, must jump through hoops for months and months to get a solid answer. Miss Debbie and all medical staff were so kind, even though I had my 3 year old autistic kiddo with me. I saw Yvonne first (who is THE sweetest ❤️), and she immediately gave me hope after viewing all my images at my appointment, I left in happy tears. All of my fear, anxiety, and depression was lifted as I left the building, as I thought I was going to live the rest of my life in pain (at 38). Dr. Bruggeman saw me a few days preop, and explained everything very clearly, especially the risks associated with a second surgery. The following week he performed my surgery flawlessly…. it’s probably a bit too graphic to post photos, but you would not believe the difference in the incision from my first surgeon in Jan to Dr. B’s surgery in June on my spine. It was half the size, and I swear to you, besides the day of surgery, I needed ZERO post op pain medication. It was incredible, I was ready to go back to work at my desk job immediately.Just do research… Dr. Bruggeman is hands down the best spine surgeon in San Antonio 😊
Winter ZamoraWinter Zamora
22:56 23 Jun 23
Felt supported and heard on each visit I had here. They are very prompt and provide excellent knowledge and resources for their patients. PA Ruiz was attentive and made I left with all questions addressed. Miss Debbie at the front desk was incredibly sweet and helpful when I first contacted this office and made me feel warm and welcome when ever I interacted with her in office.
I saw Dr Bode today. Great guy! Listens and looks at you when he is speaking to you. Includes you and asks how you feel about it. Would def recommend.
Nick RicketsonNick Ricketson
18:02 10 May 23
Amazing group of people. All the ladies are friendly and you can tell they care. My dr. She was straight forward and polite I enjoy having her as my dr. Any vets out there needing your back taken care of go here you will not be disappointed.
Russell EndsleyRussell Endsley
00:31 23 Apr 23
I was rolled into surgery in the worst pain of my life and a day later – I skipped out of the hospital pain free. Nearly four months later – I feel better than I have in 20 years. Can’t even see the surgical scar and still pain free. Dr. Bruggeman is a wizard in the operating room and his magic wand made my problems disappear! Only surgeon I would ever recommend for spine surgery.
El.koolinaEl.koolina
16:10 05 Apr 23
I had back surgery in 2015 performed by Dr Bruggeman. I can honestly say he changed my life. After an ALIF on my L4-5 spinal fusion I was finally able to get back better mobility. Every nurse and doctor here are outstanding!
Kim BKim B
16:04 07 Feb 23
Dr Bruggerman operated on my neck last year and I can move it, I no longer am staring at the ground 24/7, I can turn it, twist it and look at the sky! I believe he uses magic in his surgeries. Kim is wonderful, kind and understanding of what I’m going through with my pain. She helps me understand what can be done to make my back better and their team has already improved my quality of life. They are now working on making my lower back pain better.Let’s not forget the office staff, they are all so nice and welcoming and clarify everything I need to do for my upcoming procedures and appointments.
Denise De La GarzaDenise De La Garza
17:01 02 Feb 23
Just left Dr. Bruggemans office and I would absolutely recommend this Dr and his staff. His office is super nice and very clean, they were all very sweet and make you feel so comfortable as soon as you walk in! Dr. Burggeman and Mrs. Kim Ruiz were amazing at explaining what was going on with me in terms I could understand which was very helpful!!! Thank you all so much for everything!!!
Ann PieniazekAnn Pieniazek
22:51 19 Jan 23
This was my 4th surgery with Dr Bruggeman – 2 cervical & 2 lumbar. I would go anyone else. Dr.B, his assistants Kimberly & Yvonne and the rest of the staff are the best! Knowledgable, great at keeping on schedule and friendly. I have had full confidence having them treat me and know that they are truly concerned about treating my issues. Also, I’m super impressed with their Pre-op Center that handles the exam & labs for your upcoming surgery. They also set post-op TeleMed calls after surgery to check on you, answering questions, prescribing meds if needed and the personal favorite just to see how your are. All around they are concerned with your well-being from helping you from the time you walk thru their doors, treatment plans, the mental ups & downs with diagnosis, pain management, Pre-op/Post-op, etc. TexasSpine Care is best well-rounded practice! You are in great hands from day one, when you make your appointment with Debbie for that initial visit, with an excellent surgeon, staff & a complete practice that will help you get thru this difficult time.
369 432369 432
16:55 13 Jan 23
This was my first visit to the Texas Spine Care Clinic and I’m very impressed.The staff is very kind and attentive. I had a near zero wait time and was treated as if I was their only patient in the office and their attention to every detail was very assuring.I sincerely look forward to my follow-up visit as I know that I am in great hands.Thank you so much.
Denise GarzaDenise Garza
19:24 08 Jan 23
This was my 1st visit. I’ve never been more impressed with a medical practice. The entire staff was very friendly and professional. The medical staff made me feel heard. Very clean and well organized I felt a peace in trusting them with my problems.
Robert HarrisRobert Harris
16:35 10 Nov 22
From the time I entered the reception zone until the time I left their office, I was VERY impressed by the congenial, caring and very professional atmosphere and the personnel that made it so!I was the VP of Operations for a large cardiology practice and I can say from experience that Dr. Bruggeman and his entire staff are exceptional! One of the BEST practices I’ve ever stepped foot in for sure and I am left wondering how you were able to recruit Angels to work for you?THANK YOU Dr. Bruggeman for the peace and assurance that you imparted to me and kudos to you and all of your precious staff members for working to go way beyond being good to being totally exceptional!
Montgomery StewartMontgomery Stewart
15:42 21 Oct 22
Dr. Bergerman is very friendly attentive and is very prompt in getting you the best treatment needed for your complaints. His staff is very helpful and professional. The front desk is is exceptional and helpful. At this office I don’t feel like some other health care providers where everything is just professional and once you pay you get treated and leave. You are free to ask questions and if you are not sure they’re never too busy to help. I would recommend others to this off.
Excellent care, the level of care and expertise are commendable. Complete and precise explanation of what is happening and the potential plan of care was discussed at length. We never felt rushed and our questions were answered with care and compassion. Highly recommend
Admin UserAdmin User
21:18 01 Aug 22
Fantastic. Very efficient and friendly office. Very competent at providing services and scheduling. Dr. Bruggeman did two surgeries on me. Both came out absolutely fantastic! I could not recommend him more. Dr. Bruggeman does not need the practice at surgery. If he says you need surgery, you really should listen to him.
Cynthia LockeCynthia Locke
17:46 12 Jul 22
Absolutely the best in SA! Can never thank Dr.Bruggeman and his extraordinary staff enough, for giving me the absolute best care and treatment before and after my disc replacement. Wouldn’t trust anyone but them for any spinal surgeries. So happy with my results!
Army VeteranArmy Veteran
18:49 21 Jun 22
Went to Texas Spine Care Center for the first time today, and my experience was AWESOME! From the two ladies at the front office counter who greats you with a smile and professionalism. The office is very upscale, clean and very inviting. The wait time was short to be called back to see the care representative. The exam room was clean, bright and upscale. I was seen by Dr. Yvonne Paredes who was very professional, and provided in detail information about my medical concerns. She explained what her recommendations would be to bring me some relief from my condition and pain. I highly recommend giving TSCC an experience, you will definitely enjoy it.James W
Gloria FulkersonGloria Fulkerson
18:04 14 Jun 22
I have had two surgeries performed by Dr. Bruggerman since Feb. 2019. One was a fusion in the lower neck/upper spine. The other was implanting a spinal cord stimulator. Both surgeries were successful and helped me to get my life back. I would highly recommend his office! His team of employees are awesome! Everyone is very nice, compassionate, and helpful. My stimulator is made by Boston Scientific. Dr. Bruggerman’s office coordinated my appointments with Boston Scientific so that a representative was there for the appointments along the way. He also worked very well with my pain management doctor, Dr. Tisdell. I had a wonderful team of medical professionals all the way around!
Johnny BacyJohnny Bacy
17:49 26 May 22
I am very happy with the results from my neck surgery. I also really enjoy seeing ladies at the front desk, Faby does it all. Ms Dora is always so pleasant and great at her job. I have already recommend my family to come here. Very Happy!!! 😃
Jeff TuffsJeff Tuffs
16:55 13 Apr 22
Very professional, and the conversation was understandable to even a layman. They didn’t try to push an agenda, but instead provided options.Very satisfied with my visit.
Yesenia MartinezYesenia Martinez
16:42 04 Apr 22
Thank you Everyone from Texas Spine & NuHope for offering what was needed in the process of a journey & a chapter of my life. With the hope and believing God was with me every step of my journey. I was bless to meet Dr. Adam Bruggeman as my spine doctor/surgeon & his medical team assistants, the care that was much needed!The surgery was a success, recovered well, was active again going back to the gym faithfully but after 2 years feeling pain again due to alarming physical and mental pain.By the Grace of God I am healed in not needing a second surgery that was going be quite different than the laminectomy surgery.God is Good. I thank God for medical teams and doctors that have the knowledge and guidance with the gift of helping others that are in need of Medical Necessity, God bless you All.Do not have fear of what God is able to do and what a surgery can do that is needed to live a better lifestyle to reduce the pain or have no pain at all.Thank you.-Yesenia
Lupita FloresLupita Flores
18:43 11 Mar 22
I have had 2 surgeries with Dr. Bruggeman and have done well. Dr Paredes is very courteous, professional, and treats us like family. All the staff is super friendly. I highly recommend this practice.
Mario GonzalezMario Gonzalez
20:16 28 Feb 22
This was my first time surgery and I was confident to leave this kind of surgery on Dr Adam Bruggeman.
Heather BlakleyHeather Blakley
12:04 01 Feb 22
I could write a novel but will try to be brief. I spent a large portion of my life ignored for the serious pain I lived with and Dr. Bruggeman discovered exactly what I was living with. It’s a rough road but he has made such a huge difference in my quality of life. I thank God I am in his care. His staff is hands down the best I have ever experienced. Dr. Bruggeman and his staff are all smart, kind, professional and there to help in every way. God bless you.
js_loader