Understanding Your Insurance Benefits

Insurance benefits are complex, and, at times, the fine print in each policy is hard to understand. Promotion Physical Therapy wants you to know we’re here to help. We have seasoned Patient Coordinators on our staff that can assess your policy and provide you with a detailed description of your benefits. To start, most ancillary services, such as physical therapy, are subject to an annual deductible.

In an insurance policy, the deductible is the amount of money you are responsible for before an insurer will pay for certain services on your behalf. This deductible corresponds with a benefit arrangement. Most insurance benefit arrangements run on a calendar year – January 1 to December 31. However, some insurance policies run on a fiscal year or plan year and the start date is subject to the policy you choose. For example, your benefit arrangement could start September 1 and medical expenses will accumulate towards your annual deductible from September 1 to August 31.

Once you have met your deductible, your insurance company will begin to pay a portion of your medical services. The portion of your medical expenses the insurance company pays to a provider is known as a co-insurance. For example, some plans have an 80/20 co-insurance benefit level. This means after your annual deductible is met in full for the current benefit arrangement period, your insurance company will pay your provider 80% of your medical expenses and you will be responsible for the remaining 20%.

*Reminder: Visits to your family doctor or PCP generally fall under a normal office visit, not a deductible.

Additionally, insurance plans may include something called an out-of-pocket maximum. This out-of-pocket maximum is a set dollar amount within the policy and is the maximum amount you will pay out-of-pocket within the benefit arrangement period.  Once the out-of-pocket maximum has been satisfied, the insurer usually begins paying your medical expenses at 100%. This is great news!

Appointment times are available for 2014. Schedule your appointment today and start 2015 off with confidence when it comes to your health!

If you have questions or are unsure of what your insurance plan will cover, please feel free to call our office at (210) 479-3334. Our warm and friendly Patient Coordinators will be happy to assist you and can verify your insurance benefits to provide you with a detailed insurance consultation.

We will be here for you every step of the way. “Getting you back to the things you love faster”.

-Jessica Hendry, Front Desk Supervisor
Promotion Physical Therapy