Understanding your Health Insurance
Health Insurance can be incredibly confusing, so what do you do before seeing a physical therapist and you want to try and prepare financially for the visits?
We would like to help you understand some of the terms we and the insurance companies use so that you are as prepared as possible financially to see your physical therapist.
Deductible:
A monetary amount set by an insurance company that must be paid out of pocket by the patient before anything is paid for by the insurance company. Many patients become confused when they hear that their insurance ‘covers’ physical therapy and they end up getting a bill anyway. What the insurance company is saying, in actuality, is that the patient may see a physical therapist under that insurance plan, NOT that the visits will be paid for. If a patient has a $1000 deductible, they would be charged for each medical visit in its entirety until they’ve paid $1000 out of their own pocket. Only then will the insurance begin to pay for charges.
Co-pay:
Some health plans charge a co-pay for services. This is a set amount that a patient will be asked to pay at time of service. Co-pays can vary; some are as low as ten dollars a visit for physical therapy and some as high as ninety dollars a visit. It’s important to note that these do not go towards paying your deductible!
Co-insurance:
Some plans have co-insurance instead of co-pays. Co-insurance is a percentage owed by the patient, and usually applies after a deductible is met. If a patient has a $1000 deductible, with a twenty percent co-insurance, that would mean that after the patient has met their $1000 deductible, they will begin being charged only twenty percent of the cost of the medical visit.
Out of Pocket:
When an insurance plan has a deductible and co-insurance, it will also usually have an out of pocket maximum. If a patient has met the ‘out of pocket’, the insurance company will then pay for their medical visits in full until the beginning of the new plan year when everything resets. For example, if a patient is paying a twenty-dollar co-pay and then meets their set out of pocket of $1000, they will no longer be charged their co-pay.
Some insurance plans may also require the patient to have a referral from a doctor in order to receive physical therapy, or an authorization process that must be adhered to before treatment begins. These are things that we at Dee PT will find out for you and advise you on after you’ve provided us with your information, but before you are seen for treatment.
What Our Office Will Do For You:
The good thing to know about your insurance coverage for physical therapy is that at Dee Physical Therapy the front desk staff will collect all of your information before your visit and find out as much of the pertinent information for you as possible. We will call your insurance company before you come in, verify your benefits to the best of our ability, find out what your deductible, co-pay, or co-insurance is, and ask if you need any kind of authorization or referral to be seen. The front desk staff will then go over your benefits with you when you arrive for your first visit and answer any of your questions to the best of their ability.
We do ask that patients be as informed as possible about their insurance coverage, as in the end it is the patients’ responsibility to be aware of their benefits, and bearing in mind that medical offices will occasionally receive incorrect information from a patient’s insurance carrier at the time of a call.
At Dee Physical Therapy we want you to be informed and feel comfortable with all aspects of care, and that includes the insurance aspect of receiving treatment. Our goal is always to make you feel good again!