Health Insurance FAQ’s

1. Why do I have to pay a copay?
Is this different than co-insurance? Do I pay this to the insurance company or to the provider’s office?
A copay is a fix fee you pay when you have an appointment. A coinsurance is a percent of the charges that are submitted to the insurance company. Copays, coinsurance and deductibles are paid to the provider’s office because these are related to the appointments you have with them.

2. What is a deductible?
How is it different than my premium?
The deductible is the amount you have to pay out of pocket each year before your insurance will start paying on your visits. You only pay the deductible when you visit the doctor. Once your deductible is satisfied, insurance will start paying on your appointments.
The premium is the cost you pay each month for having insurance.

3. What is secondary insurance?
Secondary insurance in just another insurance plan that can pick up your remaining balance after your primary insurance has paid. This is common if you are covered by a plan through your work (primary) and a plan through your spouse’s work (secondary).

4. What does it mean if my insurance requires pre-authorization?
Pre-Authorization means we have to get permission from your insurance company to treat you. Often we are allowed to use our initial evaluation to get information on what we will be treating. We then provide that information to the insurance company. Typically, preauthorization is used to determine the medical necessity of the treatment you seek.

5. If I have to pay out of pocket (like for my deductible), why is the service considered “covered” if the insurance isn’t paying anything? Why wouldn’t I just pay out of pocket without going through insurance?
Even though you have to satisfy your deductible before insurance pays on your visits, your insurance will still take a provider discount off the charges that are submitted. If you decide not to go through your insurance, you may end up paying MORE out of pocket because you will not receive this provider discount.

6. Do I have to have a prescription or referral to come to physical therapy?
It depends on your insurance plan. Sometimes they require a physician’s note, also called a prescription, indicating you need physical therapy. Sometimes they require the doctor’s office to notify them (the insurance company) that they would like to send you to physical therapy. This is called a referral. When in doubt, check with your insurance company to see what they require.