Common use of Coinsurance Clause in Contracts

Coinsurance. A share of the costs for services that this Plan covers. This amount is calculated as a percentage ⎯ a percentage that We pay and percentage that You pay. (For example, We pay 80% for a service and You pay 20%.) Company – Blue Cross and Blue Shield of Louisiana (incorporated as Louisiana Health Service & Indemnity Company). We may use common words to describe the Benefits provided under this Contract. We, Us, and Our mean Blue Cross and Blue Shield of Louisiana, incorporated as Louisiana Health Service & Indemnity Company. Complaint – An oral expression of dissatisfaction with Us or a Provider service. Complication(s) – A medical condition, arising from an adverse event or consequence, which requires services, treatment or therapy and which is determined by BCBSLA, based on substantial medical literature and experience, to be a direct and consequential result of another medical condition, disease, service or treatment. Solely as an example, a pulmonary embolism after Surgery would be a Complication of the Surgery. Congenital Anomaly – A condition existing at or from birth, which is a deviation from the common form or norm. Only deviations that impact bodily functions are covered. Examples of Congenital Anomalies that do not impact bodily function and are not covered include, but are not limited to: protruding ears, birthmarks, webbed fingers and toes, and asymmetrical breasts. Cleft Lip and Cleft Palate are covered Congenital Anomalies; other conditions relating to teeth or structures supporting the teeth are not covered. We will determine which conditions are covered as Congenital Anomalies. Consultation – Another Physician’s opinion or advice about Your evaluation or treatment which is given after the attending Physician asks for it. Consultations do not include the following: ◼ Those that Hospital rules and regulations require, ◼ Anesthesia Consultations, ◼ Routine Consultations for clearance for Surgery, or ◼ Those between colleagues who share medical opinions as a matter of courtesy and normally without charge.