Understanding Health Insurance Basics
What Your Medical Supply Company Wants You to Know
GOT INSURANCE? Don’t forget to read the small print…
We get it—health insurance can be a pain. Between waiting on hold with impersonal call centers and trying to decode your coverage, it can feel like you're stuck in a never-ending game of "guess what’s covered?"
At Star Valley Medical Supply, we’ve spent hours on the phone just like you. We know how confusing insurance billing and reimbursement can be, especially when it comes to durable medical equipment (DME) like CPAP machines, oxygen tanks, braces, and more.
So let’s break down the basics of your health insurance in plain English, and give you the power to make sense of your benefits.
What Is Health Insurance, Really?
Your insurance is a contract between you and your insurance provider. You agree to pay them a monthly fee (called a premium), and in return, they agree to pay a portion of your medical expenses.
But—and it’s a big BUT—what you actually pay out of pocket depends on a few key terms:
Premium
Deductible
Co-Pay
Co-Insurance
Out-of-Pocket Maximum
Let’s break those down:
Common Health Insurance Terms (and What They Actually Mean)
Premium
Your premium is the monthly fee you pay just to keep your insurance plan active. Think of it like Netflix or Spotify—if you stop paying, you lose access.
Deductible
Your deductible is the amount you have to pay out-of-pocket each year before your insurance will pay anything.
Example:
Your deductible is $500. You have a procedure that costs $2,000.
You pay the first $500. Your insurance pays part of the remaining $1,500 (after factoring in your co-insurance—more on that below).
Co-Pay
A fixed amount you pay for specific services (like a $15 doctor visit or $10 prescription).
❗ Important Note: At Star Valley Medical Supply, we don’t use co-pays. We bill through co-insurance instead.❗
Co-Insurance
This is a percentage of the bill that you are responsible for, even after your deductible is met.
Example:
Let’s go back to that $2,000 procedure:
You pay $500 deductible
You’re left with $1,500
Your insurance pays 80%, and you pay the remaining 20%
That’s $1,200 paid by insurance, and $300 by you
Total out-of-pocket so far: $800
Out-of-Pocket Maximum
This is the total amount you’ll ever have to pay in a year before your insurance pays 100% of your bills.
Example:
Your out-of-pocket max is $5,000
You’ve already paid $800 (deductible + co-insurance)
Now your remaining max is $4,200
In-Network vs. Out-of-Network: Why It Matters
Here’s where things get even trickier…
Most plans split your coverage into:
In-Network Benefits
Out-of-Network Benefits
What you pay toward in-network care does not count toward your out-of-network out-of-pocket maximum. That means if you use a provider not in your plan’s network, you're starting from zero again.
Yikes. Yeah, we think that’s crummy too.
That’s why it's so important to check if Star Valley Medical Supply is in-network for your insurance plan. (Hint: We work with most major carriers.)
So… Why Does This Matter for Medical Equipment?
If you're getting CPAP supplies, oxygen concentrators, wheelchairs, or any other durable medical equipment, insurance will typically help cover the cost—but only if you're following their rules.
That’s where we come in.
We walk you through the paperwork
We help explain your co-insurance
We follow up with your insurance so you don’t have to
We fight to get your reimbursement processed right—the first time
You shouldn’t need a PhD in fine print just to breathe at night or walk safely at home. We’ll help you understand exactly what your plan covers, what it doesn’t, and how to make the most of it.
Final Thoughts: You Don’t Have to Do This Alone
Health insurance isn’t fun—but it doesn’t have to be terrifying either. At Star Valley Medical Supply, we work with you, not just your insurance provider.
Have questions? Need help checking your plan?
Give us a call—we’d love to help!