Health Insurance 101
What every patient with health insurance needs to know but is afraid to ask.
Here at Progressive Physical Therapy, we would like to help you obtain what you are entitled to if you have health insurance for the year. We recommend you use your insurance card to fill out the Health Insurance Worksheet then, call your insurance company with the number on your insurance card and ask them the questions included on the Health Insurance Worksheet. Keep the information handy because you need to know this information to help us help you.
Helpful Healthcare Insurance Terminology:
Benefit Year: The annual cycle in which a health insurance plan operates. At the beginning of your benefit year, the health insurance company may alter plan benefits and update rates. Some benefit years follow the calendar year, renewing in January, whereas others may renew in late summer or fall.
Benefit: A term referring to any service covered by a health insurance plan in the normal course of a patient’s healthcare.
Coinsurance: The amount you are obliged to pay for covered medical services after you’ve satisfied any co-payment or deductible required by your health insurance plan. Coinsurance is typically expressed as a percentage of the charge or allowable charge for a service rendered by a healthcare provider. For example, if your insurance company covers 80% of the allowable charge for a specific service, you may be required to cover the remaining 20% as coinsurance.
Co-pay: A set fee that your health plan may require that you pay at each visit for a covered service. For example, your health insurance plan may require a $35 co-payment for an office visit.
Deductible: A specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims. Copays are not credited toward your deductible.
Maximum Out-Of-Pocket Costs: An annual limitation on all cost-sharing for which patients are responsible under a health insurance plan. This includes deductibles, copays, and coinsurance.
Medical Necessity: A basic criterion used by health insurance companies to determine if healthcare services should be covered. A medical service is generally considered to meet the criteria of medical necessity such as teen depression rehab when it is considered appropriate, consistent with general standards of medical care, consistent with a patient’s diagnosis, and is the least expensive option available to provide a desired health outcome.
If you still have questions regarding your insurance coverage, call our office (907) 748-0022.