It’s that time of the year again! A new insurance year!
We understand that insurance can be complicated so we decided to break down some terminology you might be hearing from your doctors’ offices.
Deductible: The amount owed at the beginning of a new insurance year.
This is a word that you might not have heard from us if you began treatment towards the end of the year. This is a contracted amount of money that is owed before the insurance company will cover services at their contracted percentage (in most cases 100%). It’s the doctors offices’ responsibility to collect this. This amount includes any doctor that bills your insurance company, not just one of them. Once this amount has been met, you won’t have to worry about it until the next calendar year!
Co-insurance: A percentage of money owed after deductible is met.
A co-insurance might not apply to everyone. Certain insurance companies do not cover services at 100%, which results in the member having to pay the contracted amount that is not covered by their insurance company. For example, if an insurance company only covers 80% after the deductible has been met, then the member is responsible for 20% of the cost of services.
Max Out-Of-Pocket: The maximum amount owed per year according to the insurance plan contract.
Maximum Out-Of-Pocket is exactly as it sounds - the maximum amount of money you will have to pay out of your pocket! Once this contracted amount has been met, you won’t be responsible for any more charges of any kind.
Copay: The amount of money owed at the time of service.
A copay is the amount you will have to pay at each visit. This amount can vary based on whether or not you have met your deductible, or if you have met your Max OOP (you won’t have to pay anything).
Per Calendar Year: An insurance plans time contract. (January 1 to December 31)
Although not all, the majority of insurance companies contract their policies during a calendar year (January 1 - December 31). Meaning, your deductible and maximum out-of-pocket will go back to zero every January 1st. This also means that your maximum number of visits will re-up (for plans with a maximum)!
Authorization: Permission from an insurance company for treatment.
In some cases, insurance companies want to make sure that treatment is medically necessary before paying. In these cases they have “check-ins” to see how the member is progressing. From this review, they will authorize a specific amount of visits in a certain amount of time. When the visits are all used up, another medical review will be required. But don’t worry, we handle all of this for you!
Prescription: A note from a medical doctor for physical therapy.
Many insurance companies don’t require a prescription for physical therapy, but it is always good to have! If you have Medicare, you don’t need a prescription for the first 30 days. However, after 30 days a medical doctor will need to write a prescription to continue physical therapy.
Referral: A suggestion from a doctor for treatment or evaluation to another doctor.
Sometimes, we’ll find that your injury would be better assessed with an imaging and we will refer you to an Imaging center for the appropriate exam. In other cases, we might refer you to a different specialist doctor if we feel that will better help diagnose or treat your injury.
For more information, you can contact your insurance company at the provided customer service number found on the back of your insurance card.
We’ll also call for your benefits when you make a new appointment!