November 5, 2019 – As we near the end of the year we get more and more questions about our patient’s insurance, their benefits, and how they work. In this blog we will take a few minutes to dive deeper into insurance vocabulary and how it relates to physical therapy.
Below are some basic insurance terms and their definitions:
Deductibles: This is the amount that the patient must pay out of their pocket before their insurance benefits kick in. If your insurance has visit limits for physical therapy these start on day one, regardless of your deductible.
Co-Insurance: This is how insurance kicks in once your deductible is met. The most common scenario is based on insurance covering 80% of the cost and you paying 20% out of pocket. However, these numbers can range from 50% to 90% based on your plan.
Co-Pay: Not all insurance plans have a copay, but those that do usually follow a different set of rules. If you have a copay it is usually applied to each visit of physical therapy. Sometimes your copay is applied to your deductible limit and sometimes it is not. This usually takes the place of your co-insurance, meaning that you will either have one or the other.
Out of Pocket: This the dollar amount set by your insurance plan that caps the amount you will spend for the year. Meaning if your out of pocket is $5000 once you have paid that money to the providers you use; your insurance will now cover all your services at 100%.
Visits: Each insurance company and plan have different limits for visit. Lower visit limits are at 30 visits of physical therapy per year or less. These plans are more restrictive on how much therapy you can use and how you can use it. More traditional plans allow for 45 visits or more of physical therapy per year. A smaller number of plans have no visit limit and are only based on medical necessity.
The truth is that every insurance company has several different plans and each of those plans has different aspects to it. At Witte Physical Therapy we will take down your information and verify your plan and then review it with you so that you know what your out of pocket costs may be. Just like you contract with your insurance company for your coverage, we too contract with them to be in their network. Thus, we are subject to their contract prices and fees. So, when choosing a physical therapist and physical therapy company to work with you want to make sure you are getting the most bang for buck and are receiving care that you want to receive. This is a big goal for us, and we continue to try to work for you every day.
Your healthcare team at Witte Physical Therapy