Insurance 101
Insurance can be overwhelming, but it doesn’t have to be! We wanted to provide you with some information
to help you or a loved one navigate through some health insurance language.
These are key terms that you can expect to see from your insurance plan.
ALLOWABLE: The amount your insurance will pay for a service to an in-network provider. The Allowable Charge is typically a discounted rate rather than the actual charge.
Example: You have just visited your Physical Therapist (PT) for an evaluation. The total charge for the visit comes to $100. If the PT is a member of your health insurance company’s network of providers, the PT practice may be required to accept $80 as payment in full for the visit — this is the Allowable Charge. Your health insurance company will pay all or a portion of the $80, minus any co-payment or deductible that you may owe. The remaining $20 is considered provider write-off. You cannot be billed for this provider write-off.
DEDUCTIBLE: An amount you are required to pay before your insurance will pay (Similar to an auto insurance deductible). Plans with deductibles are typically sent a monthly statement from us, after we have submitted it to your insurance.
CO-INSURANCE: The percentage of costs you pay (for example, 20%) after you’ve paid your deductible. Let's say your health insurance plan's allowed amount for an office visit is $100 and your coinsurance is 20%.
• If you’ve paid your deductible: You pay 20% of $100, or $20. The insurance company pays the rest.
• If you haven’t met your deductible: You pay the full allowed amount, $100.
COPAYMENT: A set amount that you are responsible for paying each office visit. Generally speaking, plans with low monthly premiums have higher copayment, and plans with higher monthly premiums have lower copayment.
Whew... We realize insurance is a tricky topic to wrap your arms around, so our office does our best to verify your physical therapy benefits and inform you of any costs to you. Deductible, copayments, coinsurance, and any other restrictions such as visit limits can change from year-to-year.
Remember we're here to help! Let us know if your insurance has changed or if you receive a new insurance card. This allows us to update our records and can help you avoid receiving a bill unnecessarily.
These are key terms that you can expect to see from your insurance plan.
ALLOWABLE: The amount your insurance will pay for a service to an in-network provider. The Allowable Charge is typically a discounted rate rather than the actual charge.
Example: You have just visited your Physical Therapist (PT) for an evaluation. The total charge for the visit comes to $100. If the PT is a member of your health insurance company’s network of providers, the PT practice may be required to accept $80 as payment in full for the visit — this is the Allowable Charge. Your health insurance company will pay all or a portion of the $80, minus any co-payment or deductible that you may owe. The remaining $20 is considered provider write-off. You cannot be billed for this provider write-off.
DEDUCTIBLE: An amount you are required to pay before your insurance will pay (Similar to an auto insurance deductible). Plans with deductibles are typically sent a monthly statement from us, after we have submitted it to your insurance.
CO-INSURANCE: The percentage of costs you pay (for example, 20%) after you’ve paid your deductible. Let's say your health insurance plan's allowed amount for an office visit is $100 and your coinsurance is 20%.
• If you’ve paid your deductible: You pay 20% of $100, or $20. The insurance company pays the rest.
• If you haven’t met your deductible: You pay the full allowed amount, $100.
COPAYMENT: A set amount that you are responsible for paying each office visit. Generally speaking, plans with low monthly premiums have higher copayment, and plans with higher monthly premiums have lower copayment.
Whew... We realize insurance is a tricky topic to wrap your arms around, so our office does our best to verify your physical therapy benefits and inform you of any costs to you. Deductible, copayments, coinsurance, and any other restrictions such as visit limits can change from year-to-year.
Remember we're here to help! Let us know if your insurance has changed or if you receive a new insurance card. This allows us to update our records and can help you avoid receiving a bill unnecessarily.