What you should know about health insurance

By Kerry Elliott

Lets talk about America’s hardest language to learn…. INSURANCE. The most common complaint I hear from patients is their frustration with their health plan. I firmly believe that the root of the issue is simply a lack of understanding how their insurance works and specific coverage within plans.

The basics:

Deductible: I cannot stress enough that this is the most over looked and misunderstood aspect of your health plan. Your deductible is a annual set amount that you have to pay before your insurance will start covering your healthcare costs. This is separate from your co-pays and/or co-insurance payments.  The amount of the deductible is determined by the plan your (or your employer) chooses.  Let me emphasize this, your insurance will not begin paying for any expenses until you have paid (also known as “met”) your deductible in full.

Co-pay: Your co-pay is simply your portion of the visit cost that your insurance does not pay.  Your co-pay will always be the same amount at every visit and is due at the time of service. The amount that is billed to your insurance can vary based on what services are provided during treatment. When you have a co-pay, regardless of the amount that is billed you will always pay the same amount at each visit.

Co-insurance: Your co-insurance is a percentage of the total cost of a visit instead of a predetermined amount. This is calculated after the claim has been filed to your insurance. Most times you will either have co-insurance or a co-pay, on the rare occasion you can have both.)

Visit limit: The number of visits that your plan will approve and pay for. Many times your physical therapy limits are combined with other therapies (i.e. occupational therapy, massage therapy, etc.). Patients often get discouraged because they are only granted a small number of visits on their plan. Even though your therapy may be needed and even considered medically necessary, your insurance does not have to cover more than the set number of visits your plan allows. Should you go past your physical therapy limits, the payment of your claims becomes your responsibility in full (also known as “paying out of pocket”).

What does this all mean for you?  Regardless of your physical therapy coverage (co-pay, co-insurance, visit limit), you will have “out of pocket” expenses for your physical therapy visits from the start with co-pays (if applicable) and then on the balance until you have reached your deductible. Once your deductible has been met you are only responsible for your co-pay or co-insurance, respectively. It is also advisable that you keep track of your visits and do not exceed the number of visits your plan allows.

Insurance can be tricky and frustrating, the more you know the better you will be at navigating your healthcare journey. Understanding your insurance and the coverage they provide makes for less surprises and misunderstandings along the way.

Should you ever have any questions about your physical therapy benefits I am happy to assist you. At Movement Systems Physical Therapy we believe access to your care should not be hindered by money, we will always do our very best to work with you and your insurance plan.

Feel free to contact me at kelliott@movementsystemspt.com or 206 405 1864.