Insurance 101 for pt patients

So your insurance "covers" physical therapy-which means you won't have t pay anything out-of-pocket for your therapy visits, right? Not quite. The fact that your insurance plan covers PT services-or any other services, for that matter- doesn't necessarily mean you're off the hook as far as payment goes. In many cases, you'll still have to pay a deductible, a co-insurance, or a copayment. Talk about tricky.

To better understand the terms of your plan, you first must understand the terminology. Here are a few common questions regarding insurance lingo:

What is a deductible?

This is the total amount that you must pay for a covered service, as defined by your health plan. Copays usually very for different plans and types of services. Typically, you must pay this amount at the time of service. Again, copay amounts are fixed- which means you will always pay the same amount, regardless of visit length. In most cases, copayments go towards your deductible.

What is a Copay?

This is a fixed amount that you must pay for a covered service, as defined by YOUR health plan. Copays usually vary for different plans and types of services. Typically, you must pay this amount at the time of service. Again, copay amounts are fixed- which means you will always pay the same amount, regardless of the visit length. In most cases, copayments go toward your deductible.

What is a Coinsurance?

This type of out-of-pocket payment is calculated as a percent of the total allowed amount for a particular service. In other words, it's your share of the total cost. For example, let's say:

  • Your insurance plan's allowed amount for an office visit is $100

  • You've already met your deductible

  • You're responsible for a 20% coinsurance

In this situation, you'd pay $20 at the point of service. The insurance company would then pay the rest of the allowed amount for that visit. Keep in mind that the coinsurance amount may vary from visit to visit depending on what services you recieve. ​

What is a Coinsurance for Medicare Part B?

Medicare Part B patients are responsible for a 20% coinsurance, which typically amounts to $11-25 per visit. If you have original Medicare as your primary insurance, but you also have a secondary insurance, the secondary payer becomes responsible for the 20%. In some cases, the secondary insurance also charges a copay, coinsurance, or deductible, We recommend contacting your secondary insurance carrier to find out.

What if I can't afford to pay these amounts as frequently as I need care?

Your health is our number-one priority. As such, we are  happy to arrange a payment plan that works with your budget. That way, you can pay for your care over a time-frame that works for you. Simply ask to speak to our office/billing manager.

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