The Difference Between Co-Insurance and Co-Pay
What is an Estimated Co-pay?
Estimated Co-pay refers to a percentage determined by your insurance plan that you will be responsible for once the insurance company has processed your claim. For example: if your coverage is 80/20, that means you are responsible for 20% of the allowed charges. These percentages are set by your insurance company and they are considered an estimate because we will not know the final amount until after billing is complete. This final amount is based on your particular insurance plan. Therefore, if we ask you to pay $20.00 at each visit, the $20.00 will be applied to your ending balance. The final amount you will be required to pay is undetermined until your insurance processes your claims and sends us the information about your portion and our reduction.
What is a Flat Co-pay?
A co-pay (co-payment) is a set dollar amount determined by your insurance plan that is due at each visit. For example, if your insurance plan requires you to pay a $15.00 co-pay, this will be due each time you come for therapy.
Q. Will the money I pay at every visit cover all my expenses toward my balance?
A. The money you pay at each visit usually covers only a portion of your current balance. We expect the balance to be paid by your insurance carrier. However, you will ultimately be responsible for your balance if your insurance doesn’t cover it.
Q. Will I know the exact dollar amount I will be charged prior to treatment?
A. No, our charges will be determined after your physical therapy based on what services are received. Each person has a unique set of treatment needs. You can contact Action Rehab to discuss any questions you may have about your own physical therapy requirements.
Q. Will I be responsible for any services my insurance denies?
A. Yes, all services provided must be paid in full by either your insurance plan or you.
Q. Is there a maximum dollar amount my insurance plan will cover?
A. Some insurance plans have a maximum they will pay towards therapy. You’ll need to check with your insurance carrier.
Q. If there is a maximum dollar amount my insurance will pay for therapy per year and I was treated at another facility before being retreated at Action Rehab, will Action Rehab be aware of this?
A. No, we are only quoted your benefits pertaining to therapy through Action Rehab. We are unaware of prior charges through another facility.
Q. Why did you bill my insurance for something they were not going to pay for?
A. When we verify benefits, we are told your plan coverage only. We are not informed whether any services performed will be denied by your insurance plan.
Q. I thought my insurance covered everything 100%.
A. There may be services not covered under your plan, which can’t be determined until your insurance company has processed your claims. This can take sometimes up to 3 months.
Q. How much time will I be allowed to pay my portion of the bill once treatment is completed?
A. Contact Action Rehab to discuss available payment options.
Q. Why does my statement show a credit?
A. All monies paid at the time of service are held in your account until your insurance company pays your claims. If a credit is still available after final payment from your insurance company, the money will be returned to you.
What is Direct Access?
Forty six (46) states and the District of Columbia have passed legislation that allows direct patient access to a physical therapist without a physician referral. You may be seen by a licensed Physical therapist as long as it is medically necessary, which will be determined by the treating therapist. Physical therapists are educated at the post-baccalaureate level receiving extensive education and clinical training in the examination, evaluation, diagnosis, prognosis, and intervention of patient/clients with functional limitations, impairments and disabilities. Physical therapists are qualified to recognize when a patient presents with signs and symptoms inconsistent or outside the scope and expertise of the physical therapist and when the patient should be referred to a physician. To read more about direct access click here >>>>
Will my treatment be covered if I come by direct access?
Some insurance agencies may still require a prescription for physical therapy from your doctor. All Medicare patients will require a prescription. You will be covered by your healthcare physical therapy benefits as long as it is approved by your insurance and you have not exhausted your annual allowance. We always recommend that you call the number on the back of your insurance card to find out what your physical therapy benefits allow.
If you have any questions about your therapy, insurance or payment options please let us know: 808-597-1555. We are here to help!
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