Therapeutic Associates strives to create the best patient experience we possibly can. As a courtesy, we inform our patients about what their physical therapy benefits are at the initial office visit. The insurance benefit information our office gathers is not a guarantee of coverage. It is just an explanation of coverage. We always encourage our patients to contact their insurance providers to verify and ask any additional coverage questions. We accept a wide range of insurances. To find out if we are in-network with your insurance plan, we recommend giving our office a call or contacting your insurance company directly.

At our clinic, a good majority of the claims we send out to insurance is covered at each individual’s benefit level with no problems. The one thing that is almost never covered is TMJ (jaw) services.

Now that we have gone over a brief overview, here is a list of some common insurance lingo definitions to help make your benefits a little easier to understand.

Copay: A flat fee that you pay on the spot each time you go to the doctor or fill a prescription, in some cases this counts towards your deductible. It is possible for some visits to not have a copay, such as annual check-ups and preventative care.

Coinsurance: Coinsurance is a portion of medical cost that you pay when your health plan kicks in. Your plan kicks in after you hit your deductible. Coinsurance is just a way of saying that you and your insurance carrier each pay a share of eligible costs to add up to 100%.

For instance, if your coinsurance is 20%, you pay 20% of the cost of your medical bills. Your health insurance plan will pay the other 80%. Here’s an example. Let’s say you hit your annual deductible in June. In July, you need an MRI that costs $2,000. Your coinsurance share is 20%. That means you need to pay $400 ($2,000 x 20%). Your insurance company pays the other $1,600. The higher your coinsurance percentage, the higher your share of the eligible cost is.

Deductible: A deductible is the amount you pay each year for eligible medical services or medicines before your insurance plan kicks in. For example, if you have a $1,000 yearly deductible, you’re on the hook to pay the first $1,000 of your total eligible medical costs.

Additional Resources

Visit www.cigna.com for a full explanation of copays, deductibles, and coinsurance.

Visit www.wpsic.com for a full list of common health insurance terms.

We hope that you have found some benefit with this information. Don’t hesitate to call us or your insurance company with additional questions.

Written by Alyssa Hodgkinson and Valerie Munson.