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• Co-pays: Co-pays are often mixed up with deductibles because they are similar. Your co-pay is a fixed amount of money (such as $20 or $40) you must pay out of pocket before your insurance company begins to pay for specific expenses, such as an office visit or a prescription for medication. Typically, this is required instead of a deductible or coinsurance, and requires you to pay a set fee for a specific visit. Most health plans do not count the cost of your co-pays towards your deductible, but it’s a good idea to check with your insurance company anyways! • Co-insurance: Co-insurance is the term used to describe a percentage of what your insurance will pay to cover your health care costs after your co-pays or deductibles have been met, or if you don’t have any co-pays or deductibles. For example, say your insurance policy has a 70% coinsurance and you have a medical bill of $1,000. Your insurance company will pay 70% or $700. This would leave you with 20% or $200, to pay. • HMO versus PPO: HMO stands for “Health Maintenance Organization.” PPO stands for “Preferred Provider Organization.” An HMO plan grants you access to certain doctors and hospitals within its network. They also may require you to have a referral from your physician to see any kind of specialist. If you see a doctor outside of your HMO plan’s network, you will have to pay the entire cost of your medical services. A PPO plan is more flexible when it comes to choosing a doctor, hospital, specialist, etc. There are fewer limitations on seeing non-network providers. You can also choose to see a specialist or physical therapist without having to be referred first by your primary care physician. The premiums for PPO plans are typically much higher, as are the deductibles. What if Total Performance does not participate with my insurance?
A majority of insurance companies allow their members to see providers that are out of network, with the exception of Medicare and HMO plans. Doing this means that you can choose to see a physical therapist who does not participate with your insurance company. The insurance company will pay a specific amount towards your treatment, but it will be less than they would have paid if the therapist was in-network. Therefore, you will be responsible for paying the difference between what Total Performance charges and what your insurance company pays. Some people opt for out-of-network services because they want to receive care from a specific provider. If you aren’t sure what your out of pocket costs will be, don’t hesitate to ask your physical therapist! What if I don’t have insurance? If you don’t have health insurance to cover physical therapy services at Total Performance, it’s not a problem. You may still receive service by paying us directly, or working out a payment plan with our billing coordinator. Contact us today The list of questions and concerns when it comes to health insurance is never-ending. If you’re interested in speaking with someone about your coverage and benefits, don’t hesitate to contact our office today at 215.997.9898. We’re here and we’re happy to help guide you through the process! Sources: https://www.medmutual.com/For-Individuals-and-Families/Health-Insurance- Education/Compare-Health-Insurance-Plans/HMO-vs-PPO-Insurance.aspx https://www.choosept.com/resources/detail/understanding-payment-physical- therapy-services
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