Understanding Insurance

Health insurance can be confusing, frustrating, and just outright overwhelming. Here’s a breakdown of health insurance before you have a breakdown over health insurance!

Your deductible is what you will pay before your insurance covers any cost. Most payments you make towards a medical service will go towards meeting your deductible. Once you meet your deductible you will have either a copay or co-insurance. Disclaimer* not everyone has a deductible.

Navigating the complexities of health insurance can indeed be daunting, but understanding key terms can make the process less intimidating. After you meet your deductible, you’ll usually be responsible for either a copay or co-insurance. A copay is a fixed amount you pay for certain services or prescriptions, while co-insurance is a percentage of the costs that you share with your insurance company. It’s essential to know which applies to your plan to avoid unexpected expenses.

If you’re still feeling overwhelmed, don’t hesitate to seek assistance from resources like SimplyQuote. They offer guidance and tools to help you better understand your health insurance options, ensuring that you make informed decisions without unnecessary stress. Remember, getting the right help can simplify the process and make managing your health insurance much more manageable.

Co-insurance doesn’t mean secondary insurance. It’s what your insurance will cover once your deductible is met. If we say you have an 80/20 co-insurance, it means that your insurance will pick up 80% of the cost for the medical service so you will only be responsible for 20% of the cost. A copay is what you will pay at the time of your visit. If you have a deductible to meet, your copay will go towards meeting that. You may also see a bill in the mail as well depending on your insurance. Your copay applies towards the visit cost so it will make your bill smaller overall. For example, if you have a $30 copay but your insurance charges $100 per visit, you will see a bill of $70 for that visit since you already paid $30 towards it!

You finally reached your out-of-pocket max (OOPM), now what? Your OOPM means that you have paid the maximum amount out of your own pocket for medical services, it’s like a second deductible you must meet. Once you do meet it you can sit back, relax, and let your insurance company pay for any other medical expenses you may have throughout your contract year. Queue the sigh of relief!

Your insurance plan determines how many visits are allowed for physical therapy which is known as your visit limit. Visit limits can vary from 10 visits to unlimited visits per contract year. Some insurance plans require those visits to be authorized by them. Don’t fret, our phenomenal patient advocate team works hard behind the scenes to do just as their title states, advocate for our patients, you. What happens if you run out of visits or if your insurance won’t authorize any more? Once you exhaust your insurance options, you can chat with us about our client pay options to keep your treatment on track.

The burning question every patient is dying to know is, when can you plan to see your first bill? It can take up to 6-8 weeks to see your first bill. Many times, you can log into your account on your insurance website and see your explanation of benefits (EOB) and it will show you what you will owe from each visit before our paper bill comes to you in the mail. Your insurance determines how much you will be billed per visit. Each insurance company sets its own rates for physical therapy.

Our patient advocates work hard to find out what your insurance benefits are and to estimate your cost throughout your physical therapy journey. Within your first few visits, our advocates will give you an insurance quote as a courtesy to you so there are no surprises. We do everything we can to be as transparent as possible with your care. That said, the insurance quote we supply is only an estimate, not a guarantee. If you have questions or concerns regarding your insurance plan/coverage, contact your insurance company directly.

Hulst Jepsen Physical Therapy participates with most major insurance providers. Call 616.256.8679 or email receptionist@hjphysicaltherapy.com to see if we accept your insurance.