Insurance
Insurance can be a difficult thing to understand.
What to
Know
Deductible
A deductible is the amount you must pay out-of-pocket for healthcare services before your insurance begins covering costs. Once your deductible is met, you’ll typically pay copays or coinsurance for services until you reach your out-of-pocket maximum, at which point insurance covers 100% of costs for the rest of the plan year.
In-Network vs Out-0f-Network
In-network providers are providers that have a contract with your insurance company. You’ll generally pay lower out-of-pocket costs, such as a set co-pay or lower co-insurance rates.
For out-of-network providers, your insurance typically comes at a higher co-insurance rate and may need prior authorization. Keep scrolling to find out more about how you can be potentially be reimbursed for out-of-network services.
Referrals
In many states, including Illinois, you can see a physical therapist without a referral. However, insurance coverage may vary, so it’s best to check with your provider to confirm your benefits.
Co-pays
A co-pay is a fixed, out-of-pocket fee you pay for a healthcare service at the time of your visit. It is set by your insurance plan and varies based on the type of service. Co-pays do not count toward your deductible but may contribute to your out-of-pocket maximum. They remain the same regardless of the total cost of the service.
Co-insurance
Co-insurance is the percentage of costs you pay for healthcare services after you’ve met your deductible. Unlike a co-pay (a fixed fee per visit), co-insurance is a shared cost between you and your insurance provider. Once you hit your out-of-pocket maximum, insurance typically covers 100% of costs for the rest of the plan year.
Session Limits
Many insurance plans limit the number of physical therapy sessions they will cover per year. These limits vary based on your plan and diagnosis. To avoid unexpected costs, check with your insurer to confirm how many visits are covered and if extensions are possible with medical justification.
What is a Superbill?
For those who are paying cash/are out-of-network
A Superbill is a detailed invoice that a physical therapy clinic provides to cash-pay or out-of-network patients. It includes all the necessary information for you to submit a claim to your insurance for possible reimbursement. Reimbursement varies by plan, so it’s best to check with your insurer on out-of-network benefits before starting treatment.
