Insurance Benefits

It is important to call your insurance carrier to determine your exact benefits. Ask specifically for your outpatient physical therapy benefits. Here are six questions we recommend you ask:

1. What is my deductible?
2. What is my co-pay?
3. What is my co-insurance?
4. What is my calendar year?
5. How many visits do I have per calendar year? Do Chiropractic visits count against my physical therapy visits?
6. What are my in- and out-of-network benefits?

Types of Insurance Plans

Health Maintenance Organization (HMO)

The patient chooses the primary care physician from a list of doctors in the network. HMO's require a referral from your primary physician to your insurance carrier.

Preferred Provider Organization (PPO)

The patient chooses the doctor or hospital they wish to use. These doctors may or may not be in the network. Doctor choice is more convenient, but out-of-pocket costs tend to be higher.

Medical Savings Account (MSA)

A type of health insurance plan that combines both a tax advantaged personal savings account and a high-deductible health insurance policy. Individuals must purchase a health insurance policy before deposits can be made into the savings account, up to a limit set by law. The user of the MSA plan is expected to pay for routine health care costs from the MSA plan's savings account.

Point-of-Service Plan (POS)

Combines the features of HMOs and PPOs. You can decide whether to go to a network provider and pay a flat rate or to an out-of-network provider and pay a deductible and/or a coinsurance charge.

Indemnity Plan

Private insurance plans that allow beneficiaries to choose any physician or hospital. Most plans have a deductible, an amount that the policyholder must pay before the plan will cover any costs. After the deductible has been satisfied, plans pay a co-insurance percentage, most often 70–90% of the charges. The beneficiary pays the remainder of the bill.