Physical Therapy While Pregnant

FAQ: What Is A Benefit Limit?

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, and what is a benefit limit? Let’s discuss this some more!

What Is A Benefit Limit

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

Coverage

deductible is how much you owe for health care services before your health insurance plan begins to pay. The deductible may not apply to all health care services that you need. You might not have to pay your deductible for things like physical therapy or chiropractor visits. In these cases, the insurance company will pay some or all of the bill entirely.

coinsurance is a percentage of the costs for health care services you are responsible for paying after you’ve met your deductible. Coinsurance amounts can be different depending on the type of service. For example, there may be 10% coinsurance for chiropractic visits and a 20% coinsurance for exam visits. Some services may not require a coinsurance at all.

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. For instance, you may have a $30 copay for specialist visits, but a $50 copay for lab tests. Some services may not require a copay at all.

The out-of-pocket maximum (OOPM) is the most you will ever have to pay during a policy period for health care services. 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. 

Benefit Limits

Once your insurance starts paying for your healthcare services, you’ll want to take a look at benefit limits. Benefit limits refer to the maximum amount your insurance company will pay each year for a certain healthcare service.

For example, your health insurance company can put a cap on prescriptions or hospitalizations. They can also put a dollar limit on covered services, or the number of visits covered by a service as well. If you want to continue those services after your benefit limit is reached, you will be responsible for any costs for the remainder of the year.

For more information regarding insurance benefits, click here.

About The Author

Jaime Curl

I've explored many different fields within physical therapy, including acute care and oncology at Troy Beaumont Hospital, elementary through high school levels in the Troy School District, and outpatient physical therapy. As the office manager and marketer, I am able to combine my love for health and exercise science with my people skills, all with a dash of marketing and personal training. My hobbies include spending time with friends and family, baking, crafting, and watching my favorite movies or tv shows.

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