Health Insurance Guide for Patients

Understand your coverage, claims process, and how insurance interacts with your athenahealth provider bills.

Insurance Essentials

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Deductible

The amount you pay before insurance starts covering costs. Resets January 1 each year. Average individual deductible: $1,500–$3,000.

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Copay

Fixed amount you pay per visit or prescription, regardless of total cost. Primary care: $20–$30. Specialist: $40–$60. ER: $100–$300.

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Coinsurance

Your percentage share after meeting the deductible. An 80/20 plan means you pay 20% of costs, insurance covers 80%.

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Out-of-Pocket Max

The most you'll pay in a year. 2025 ACA cap: $9,450 individual, $18,900 family. After this, insurance covers 100%.

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In-Network

Providers who have agreed to contracted rates with your insurer. In-network care costs 3–5x less than out-of-network. Always verify before visiting.

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EOB

Explanation of Benefits — a document from your insurer showing what was billed, what they paid, and what you owe. Not a bill, but compare with every provider statement.

How Insurance Works With Athena Health Bills

The Billing Process

You receive care from an athenahealth provider
The practice submits a claim to your insurance
Insurance processes the claim and sends you an EOB
After insurance pays their share, your provider sends your statement
You pay your portion via QuickPay Portal or patient portal

Your Patient Responsibilities

Provide current insurance information at each visit
Verify your provider is in-network before appointments
Compare your bill with your EOB before paying
Contact billing if your bill doesn't match your EOB
Pay your balance by the due date to avoid late fees

Insurance & Coverage Guides

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Insurance