Medical necessity is a decision by your health insurance plan that your treatment, test, or procedure is necessary for your health or to treat a diagnosed medical problem.
Coinsurance is your share of the costs of a health care service. It’s usually figured as a percentage of the amount we allow to be charged for services.
Out-of-pocket maximum is the most you have to pay for covered services in a plan year. After it is spent, your health plan pays 100% of the covered benefits.