Insurance…..oh no! Breaking down the barriers to care.

Insurance – oh what horrifying word. The truth is insurance can be scary if you do not know what it is exactly you are reading. It sounds like a bunch of mumbo jumbo. Deductible, co-insurance, co-pay, in-network, out of network, and let’s not forget to mention all the little codes they put on your Explanation of Benefits and expect you to know what they mean by them. Sure they give you explanations of everything but if you truly do not understand the wording you will be confused.

Does anyone ever really understand the language of insurance companies? The answer is no. No one really truly understands their insurance benefits and knows exactly what their insurance company is talking about when it comes to your benefits and when they send your explanation of benefits. Well that’s what we are here for!

When you go see your physician and they prescribe you physical therapy, I bet a thought you might have is – does my insurance cover it? Yes, 90% of insurance plans cover physical therapy. There is that small 10% of plans that do not cover it.

While your insurance may cover it there may be an out of pocket cost to you! So how do we determine what your out of pocket cost will be? Normally, we will verify eligibility online or with a phone call. When we verify your insurance we obtain your benefits for physical therapy – we will find out if you have a deductible and if it applies to physical therapy, if you have a copay or if you have a co-insurance, how many visits you are allowed, if you need a script or referral from a visit.

What does deductible, co-pay, co-insurance and out of pocket mean?


What is a deductible? A deductible is a specified amount of money that the insured must pay before an insurance company will pay a claim: You will be responsible for your entire deductible before your insurance will pay for anything.


Do I have a copay? A copay is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service. How it works: Your plan determines what your copay is for different types of services, and when you have one.


What does coinsurance mean? Coinsurance is the percentage of costs you pay after you’ve met your deductible. You will never have a copay and a coinsurance. There may be these slight procedures that require a copay and coinsurance but that is very rare.

Out of Pocket 

The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn’t include: monthly premiums.

If you have any further questions or would like to set up an appointment please feel free to reach out to one of our Patient Care Coordinators at either office or request an appointment above.


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