Blog Post

INSURANCE FAQ'S

  • By 7011224491
  • 01 Apr, 2019

1.     What is a deductible plan?

Answer: A deductible is an amount of money the insurance has you pay before they begin to pitch in. In-Network healthcare applies to your deductible. Some people have an individual and a family deductible.

An individual deductible is the amount spent by that individual subscriber. A family deductible is the amount spent by all the people on that plan.

Once one’s individual deductible has been met, the insurance will either cover the whole appointment for that person or have them pay a co pay with that appointment depending on the plan. Once the family deductible has been met, the insurance with either cover the entire appointment or all except a co pay for all members of the plan.

2.    What is an out of pocket maximum?

                                         

Answer: There are two options for what can happen once you reach your deductible depending on your plan. If you have an out of pocket maximum, you will continue to pay around 20% or a co pay until a certain dollar amount, the out of pocket maximum, amount has been reached. Then the insurance will pay 100%. If you do not have an out of pocket maximum or if your out of pocket is the same as your deductible, you will be covered at 100% or have only a co pay once you reach this amount.

 

3.    What happens when I have a co pay plan?

 

Answer: A co pay is a set amount that you pay per appointment to contribute to your out of pocket maximum or deductible. After paying your co pay, the insurance will cover the rest of the appointment.

 

4.    If I have Medicare or Medicaid will I have to pay anything for Physical Therapy?

 

Answer: Your insurance covers the appointments themselves however, if you decide to get orthotics, bands, balls, etc. insurance will not cover this.

 

5.    What happens when I have a secondary insurance?

 

Answer: The primary insurance will be billed first. Then, they will send the remainder to your secondary insurance provider. They will pay some or all of the remainder and then send the rest to you. Sometimes a deductible has to be met before secondary insurance will pay.

 

6.    How many visits do I get for Physical Therapy?

Answer: This depends on your plan. For many plans, such as Blue Cross Blue Shield of Vermont, there is a limit of 30 visits per calendar year. For other insurance plans such as Medicare or Medicaid, it goes by a dollar amount which is influenced by the billed amount. For Inspire Physical Therapy, we keep this number low so that you can have 15 guaranteed visits through Medicare/Medicaid. After these 15 visits, we can request more. Some plans group all therapies including speech, occupational, physical, and massage into the same appointment category. Be sure to tell any PT or health care provider if you have been seeing someone else so they can keep track of how many visits you have left.

7.    How do I find out my Physical Therapy Benefits?

Answer: There is a member phone number on the back of your insurance card that you can call. If it is an automated message, select eligibility/benefits, give the ID number from the beginning of the card, you name, your date of birth and if you cannot receive your benefits after giving your information, press zero to speak to an operator. Some allow you to speak with a representative right away so you could try and bypass the system by saying “Speak with a representative” or “Operator.”

 


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