When it comes to understanding your insurance benefits, it can cause you a lot of confusion and be a headache to deal with. Most insurance plans will break down your benefits for you when you sign up, but it can still be confusing. Deductibles, Out-of-Pockets, Co-Insurance, and Copays, are the main words to look at when it comes to insurance plans and understanding what is owed when it comes to using your medical insurance.

A deductible is the dollar amount you are required to meet before your insurance company will pick up any percentage of your claims. Along with your deductible, there is an out-of-pocket amount, typically when that out-of-pocket amount is met, then your services are covered at 100%, and your insurance pays your medical claims in full. That is always a great feeling!

Then you have Co-payments; this is the dollar amount that is usually owed upfront to your medical provider on the day you receive your medical service. Typically, if you pay a copay, your insurance provider picks up the remainder of what is owed. Patients who have Medicare as their primary insurance are not always aware that a Medicare deductible has to be reached every year before Medicare picks up that 80%. Some secondary insurances pick up that balance, but not all do, so in the event that the secondary insurances do not pick it up, that is patient responsibility.

At Premier Physical Therapy, we make it easy for you by verifying your benefits ahead of your initial appointment. So when you come in for that first visit, you are aware of your physical or occupational therapy is going towards your deductible or if it is going towards a copay. We want you to be comfortable and have knowledge of what you could be responsible for. We are providers for almost all major insurance companies, and if you have insurance that we are not in-network with, wework with you to ensure you get treated for the pain or lack of function you are experiencing.

Using your medical insurance shouldn’t be something you dread dealing with. You should be comfortable knowing your benefits and what your insurance pays, or what you could be responsible for. You can always call your insurance provider and speak to member services to better understand what you could be liable for before receiving treatment or seeing your doctor. You can always request your EOB’s (explanation of benefits); this explains how your insurance processed your claims. This could be helpful to you if you are unsure how much applied to your deductible or to understand what was billed and what you are responsible for. Most people tend to pay their bills without even checking how their insurance processed the claim. It’s always best to double-check than to assume your insurance processed your claim correctly.

At Premier Physical Therapy, we strive to make sure you are comfortable and understand your Physical and Occupational Therapy benefits. So don’t wait to see a healthcare provider because you are not sure about your insurance; take the steps to make yourself feel better to get back to what you enjoy doing.