Every insurance carrier has a payment rate for each test, procedure, and medical service. The rates are what the insurer has decided are appropriate for these services in New York City. Insurers have different ways of deciding what is usual and customary. Memorial Sloan-Kettering's charges may be different from an insurer's rates due to the high level of care we provide to our patients. If you only have out-of-network benefits, you are responsible for paying the difference between Memorial Sloan-Kettering's charges and the carrier's usual and customary rates, in addition to your co-insurance and deductible costs.
Carrier
An insurance company that issues policies and makes payments to medical providers for its members.
(http://www.cancer.gov/dictionary)Co-Insurance
The amount (usually a percentage) of the healthcare costs for which you have to pay. You pay co-insurance even if your deductible has been met. For example, you may pay 20 percent of the cost of medical services after meeting the deductible.
(http://www.cancer.gov/dictionary)Deductible
The annual amount you must pay for healthcare expenses before your insurance company begins to pay for covered medical services.
(http://www.cancer.gov/dictionary)Out-of-Network
Physicians, hospitals, or other healthcare providers who do not have a managed care contract with an individual's insurance company. When you receive care out-of-network, you will be financially responsible for that care.
(http://www.cancer.gov/dictionary)
