Insurance Cover Physical Therapy

FAQ: Will My Insurance Cover Physical Therapy?

Insurance Cover Physical Therapy

We strive to make every patient feel valued and well taken care of.  Physical Therapy is a tool. It’s a pathway to get you to your goals. Our highly trained staff members at Borja Physical Therapy work to do their best to make your experience pleasant. So, will your insurance cover physical therapy? Let’s discuss this some more!

Will Your Insurance Cover Physical Therapy?

Typically, most insurance companies offer some level of coverage for physical therapy under each of their plans. That level of coverage can vary between each policy, however.

When it comes to plan and network types, you’re looking at the type of services that are covered in your plan. As well as the doctors you are allowed to see. These can either be in or out of network. Some plan types let you see any doctor. Other plans can limit your choices or charge you more to see out of network providers. 

The different plan types include HMOs, PPOs, POSs, and EPOs. Each plan type has a different amount of freedom for choosing providers.

Depending on your plan, you may have to meet a deductible, pay a copay, or physical therapy may be covered in full at 100% by your insurance company.

Typically an insurance policy will have a deductible, coinsurance or copayment, and an out of pocket maximum. Although every plan is different and may not have each of these, it’s important to understand them and how they work. It’s especially useful when it comes time to choose future health care plans.

Deductibles

A deductible is an amount you owe before your health insurance plan begins to pay. 

The deductible may not apply to all health care services that you need. You may not need to pay for services like physical therapy or chiropractic care. In these cases, the insurance company will pay some or all of the bill.

Coinsurance

A coinsurance is a percentage of the costs you are responsible for paying after you’ve met your deductible.

Coinsurance amounts can be different depending on the type of service. There may be 10% coinsurance for chiropractic visits and 20% coinsurance for exam visits. Some services may not require coinsurance at all.

Copayment

A copayment (or copay) is a dollar amount you pay for health care services. Copays are due after you’ve paid your deductible.

Most plans have some sort of copay for one or more services. Each service has a different copay. You may have a $30 copay for doctor visits, but a $50 copay for lab tests. Some services may not require a copay at all.

Out Of Pocket Max 

The out-of-pocket maximum (OOPM) is the most you will ever have to pay during a policy period. Your deductible, coinsurance, and copays go toward your OOPM. Once you have met this amount, the insurance company will pay 100% of all remaining covered services for that year. 

The OOPM does not include your monthly premiums. Think of your premium like paying for a gym membership. You pay $29.99 a month to use the gym. Your premium is the monthly payments you make each month to your insurance company to have healthcare coverage. 

Know Your Coverage

As a courtesy, our Billing Department will verify your insurance benefits. If you do not have in network medical benefits, please speak with our billing coordinator to discuss self-pay options. There is no payment plan option for self-pay patients.

It is VERY important for each patient to know their individual benefits so unexpected balances do not occur. The Borja PT Billing Department files with many insurances that offer several different plans. Therefore, the patient must make sure their benefits are accurate.

Workers Compensation/Motor Vehicle Accidents

Additionally, we are happy to treat patients with personal injury or motor vehicle accident claims. The billing department will need certain information to verify each claim prior to service. For example, they will need the claim number, adjuster’s name, and contact phone number. As well as the claim mailing address. 

Should the Workers Comp or Auto company deny your claims, the claims will then be submitted to your Medical Insurance. If you do not have medical insurance, however, the balance will become your responsibility.  Please let us know if you have an attorney involved, along with their name and phone number as well.

For more information about our financial policy, click here.

About The Author

Jaime Curl

I've explored various fields within physical therapy including acute care and oncology at Troy Beaumont Hospital and outpatient physical therapy. As the office administrator and marketer, I'm able to combine my love for health and exercise science with my interest in marketing and numbers skills. My hobbies include spending time with friends and family, baking, crafting, and watching my favorite movies or tv shows.

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