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Insurance is a topic many of us are not comfortable with. Understanding your changing policy and the confusing terminology feels like pulling teeth. As a result, most people don’t always look closely or avoid looking at their insurance, and that can hurt them. As a general rule of thumb, it’s best not to pay any expense without first inspecting the bill.
As a physical therapy clinic, we want to do our part to make sure you understand what you’re paying for when it comes to our services. Whether you’re completely new to medical insurance or just have questions about your policy, here’s what you should know about your physical therapy bill.
Understanding Your Coverage & Benefits
Depending on your medical insurance and condition, what is and isn’t covered when seeking physical therapy will vary. To understand your insurance benefits, it’s important to thoroughly research your insurance policy. A good start is to understand what you pay and how you pay it. For the insurance novice, here are a few key terms to understand:
- Premium. This is what you pay for your medical insurance every month. It usually covers the basic necessities but may not cover certain surgeries and additional treatments.
- A deductible is a fixed amount you must pay every calendar year before your insurance starts covering expenses. Let’s say your deductible is $1,000. After you spend $1,000 in combined medical expenses, the rest is co-insured. Copays and coinsurance amounts do not contribute toward your deductible.
- Copay. This is a fixed amount paid per covered medical appointment. The amount of the copay varies by insurance coverage, and most insurances have a higher copay if you are treated by a specialist. Most of the time, physical therapists are not listed as a specialist.
- Your coinsurance is the percentage of health care service you pay after your deductible has been met. For example, if you have met your deductible for the year and have a 20% coinsurance, your insurance covers 80% of your physical therapy and you would pay for the remaining 20% out of pocket.
- Out-of-pocket maximum. One last term for you. Combining all the earlier expenses, the out-of-pocket maximum is the most you pay per year before your insurance begins to cover all remaining expenses for the rest of the year.
Clear as mud, right? This Forbes article actually does a great job of illustrating your insurance benefits if you’re looking for more examples.
Transparency is Key
When you walk into i’move on your first day, we will have already looked up your insurance benefits ahead of time as a courtesy to you, our patient. This is not always offered at medical offices. Based on the insurance provider and policy number you give us, we look at your particular policy and verify what specific benefits you have. However, we do ask that patients also verify this information with their insurance company if they have additional questions or the insurance company does not give us exact details. We are very careful to specify that this is an estimate based on what the insurance company has told us, because on occasion, the information does change. For most insurance, we can tell you the exact deductible or copay that is expected at each appointment. We provide the information upfront before you officially commit to anything, so there are no surprises later on. You wouldn’t buy a car without knowing the price – so don’t expect anything different from your medical provider.
Paying Your Bill
Before starting physical therapy at i’move, most expenses can be determined upfront. We request payment at the time of service as frequently as possible but do understand that some people like to get their Explanation of Benefits (EOB) from the insurance company before paying the bill. In these instances, we bill monthly and request prompt payment. i’move acknowledges that medical care and treatment can be expensive and that increasingly higher insurance deductibles and copays can add up quickly. We make every effort to give patients a reasonable amount of time to pay their balance with us.
In the event that the full amount of the copay cannot be paid at each visit, or the deductible cannot be paid each month, we do offer a payment plan to assist our patients in meeting their financial commitments to us. At the time of discharge, we request that patients commit to a payment plan that will enable them to pay the balance on their account within 18 months. We understand that is not always possible, and we will work with you to come up with a plan that is doable for your budget. What we offer is fairly rare in the medical world: as long as you make a monthly payment, you are in good standing with us. We want to work directly with you to settle your bill at pace that is reasonable and sustainable for you. The best thing you can do is stay in close communication with us regarding any deviations from the plan.
Additionally, no interest rates or fees apply to your bill. Credit cards and other loans tend to charge high interest rates, but none of that applies here. As long as you are making monthly contributions, you will not be charged or fined an additional amount.
Ask Us Your Questions – No, Seriously
We have plenty of insurance experts here, and they are ready to answer your questions. Insurance can be difficult to face alone, so we are more than willing to lend you a helping hand. If you have concerns over your insurance coverage or billing, you are more than welcome to sit down with our billing specialist. We have helped clients make phone calls and sort out issues in the past, and we are happy to do the same for you today.
To start your recovery journey, schedule an appointment at i’move. To learn more about our payment plans or get answers to questions about your physical therapy bill, contact our billing specialist, Noel Shimmel at 616.847.1280 ext. 24. We want to make your recovery (and the bill) as clear as possible for you. Don’t hesitate to reach out.