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hello this is dr eric bricker and welcome to a healthcare z today we are going to be talking about payment at the time of service and so here we are in the admitting department of a hospital and when you come to the hospital typically theres a lot of pieces of paper that you sign and one of those pieces of paper is one to say that its okay for them to treat you because they are going to be like potentially sticking you with needles and using knives on you so you guys say hey thats okay and then two to say that you the patient are ultimately responsible for payment so theyll build the insurance but at the end of the day you the patient are responsible and they make you sign a piece of paper uh and thats thats just standard practice thats for everybody to know okay so two so as far as payment goes your insurance company has something called an accumulator and that keeps track of how much you have paid against your deductible and your coinsurance now lets use a specific example le