Who is responsible for making coinsurance payments as determined by a specified ratio?

Coinsurance payments are the portion of healthcare costs that a patient is responsible for after meeting their deductible. This payment is typically defined by a specific percentage ratio set forth in the health insurance policy. For example, if a patient has a coinsurance rate of 20%, they are required to pay 20% of the total healthcare costs, while the insurance covers the remaining 80%.

The patient (insured) is ultimately responsible for making these coinsurance payments directly to the service provider or facility after receiving medical services. This structure incentivizes patients to be mindful of healthcare costs, as their out-of-pocket expenses are influenced by the coinsurance rate. However, it is the insured individual who is obligated to fulfill this financial responsibility, as outlined in their health insurance contract.

Other entities, such as physicians, third-party payers, and facilities, play roles in the healthcare payment ecosystem, but they do not bear the responsibility for coinsurance payments that directly fall on the patient. The physician provides services, the facility may charge the patient for those services, and the third-party payer often covers the majority of the bill, but the specific financial obligation of coinsurance remains with the patient.