Insurance FAQs
What is a deductible?
This is the total amount you must pay out-of-pocket before your insurance starts to pay. For example, if your deductible is $1,000, then your insurance won’t pay anything until you have paid $1,000 for services subject to the deductible (keep in mind that the deductible may not apply to every service you receive). Furthermore, even after you’ve met your deductible, you may still owe a copay (fixed amount) or co-insurance (percentage amount) for each visit.
What is a copay?
This is a fixed amount that you must pay for a covered service, as defined by your health plan. Copays usually vary for different plans and types of services. Typically, you must pay this amount at the time of service. Again, copay amounts are fixed—which means you will always pay the same amount, regardless of visit length. In most cases, copayments go toward your deductible.
What is a coinsurance?
This type of out-of-pocket payment is calculated as a percent of the total allowed amount for a particular service. In other words, it’s your share of the total cost. For example, let’s say:
-Your insurance plan’s allowed amount for an office visit is $100.
-You’ve already met your deductible.
-You’re responsible for a 20% coinsurance.
In this situation, you’d pay $20 at the point of service. The insurance company would then pay the rest of the “allowed” amount for that visit. Keep in mind that the coinsurance amount may vary from visit to visit depending on what services you receive.
What is the coinsurance for Medicare Part B?
Medicare Part B patients are responsible for a 20% coinsurance, which typically amounts to $11-25 per visit. If you have original Medicare as your primary insurance, but you also have a secondary insurance, the secondary payer becomes responsible for the 20%. In some cases, the secondary insurance also charges a copay, coinsurance, or deductible. We recommend contacting your secondary insurance carrier to find out.
So, how much will I owe for each visit?
If you have not yet met your deductible, then you will be responsible for the full cost of each visit until the deductible is met. Typically, this amount can range anywhere from $50-$135 per visit. We charge coinsurances as a dollar amount equal to the percentage of the full amount for the visit. You’ll then owe any applicable coinsurance or deductible balances after we receive the Explanation of Benefits (EOB) from your insurance company. Conversely, if we find that you have overpaid, we will refund you via check as soon as possible. As for copays—these amounts rarely vary, so if your copay for physical therapy visits is $10, you will owe $10 at each visit.
What if I can’t afford to pay these amounts as frequently as I need care?
Your health is our number-one priority. As such, we are happy to arrange a payment plan that works with your budget. That way, you can pay for your care over a timeframe that works for you. Simply ask to speak to our office/billing manager.
The Self-Pay Option
If I don’t want to use my insurance, can I just pay for services myself?
The self-pay rate for all visits at Southern Rehab and Sports Medicine is $85. If the patient chooses the self-pay option, we will not bill their insurance and the amount paid for treatments will not go toward the deductible.
