Your Portion of the Bill Depends on Your Plan

Even if we participate with your insurance company/plan, you may still have a bill.  This bill is part of your contractual agreement with your insurance company, and is not a separate fee billed by Physical Therapy Plus.

It is possible to know ahead of time what you will be responsible for paying, and you can find that out by either calling the Customer/Member Services phone number located on the back of your insurance card, or by logging in to your insurance company's website.

Our Office Manager, Carole, will also call your insurance company to check your benefits and will let you know what you may owe per visit.

Read more about insurance plan terms below.

SAMPLE PLAN 1:

• $1,500 deductible (applies to Physical Therapy) 
• $25 copay per Physical Therapy office visit
• $4,000 Out of Pocket Maximum (includes deductible)

Deductible: You are responsible for 100% of the bill until you have paid out the total amount of your $1,500 deductible, across all medical bills incurred. That is to say, any medical bills you pay will contribute to meeting your deductible, not just Physical Therapy.

Copay/Coinsurance (Split the Bill): Once you have met your deductible, the insurance company begins to split the bill with you. The payment split is given in terms of a copay or coinsurance amount. Per this plan, you pay your $25 copay per Physical Therapy visit, and your insurance pays the rest, regardless of the bill total.

Out of Pocket Maximum (Insurance Pays All):  Once you have paid an amount equal to your $4,000 OOP,  the insurance company will begin to pay 100% of all medical bills and you will not be responsible for any part of the bill.

It is important to know that your insurance plan resets each year, meaning that you essentially lose your progress towards your deductible and Out of Pocket Maximum, and start over paying towards your deductible. Some plans will reset per calendar year (every January 1), and others reset per contract year (when you signed up). 

SAMPLE PLAN 2:

• $1,500 deductible (does not apply to Physical Therapy)
• $25 copay per Physical Therapy office visit
• $4,000 Out of Pocket Maximum (does not include deductible)

There are two differences in this plan compared to the previous: 

One: In this plan, the deductible does not apply to Physical Therapy. This means you will not ever be responsible for paying the deductible amount for a Physical Therapy bill, and will only need to pay your $25 copay per visit until your OOP is met. 

Two: Per your plan terms, the OOP does not include the deductible. That means you need to pay $4,000 worth of copay and coinsurance amounts across all medical treatments and services before your insurance company will begin to pay 100% of your bills. 

SAMPLE PLAN 3: 

• $500 deductible (applies to Physical Therapy)
• 20% coinsurance per Physical Therapy office visit
• $1,500 Out of Pocket Maximum (includes deductible)

In this plan, you will pay 100% of your medical bills until you have paid out a total of $500. 

Once your deductible is met, you will be responsible for 20% of each Physical Therapy bill while the insurance company pays the remaining 80%. 

This continues until you have paid a total of $1,000 worth of copays and coinsurances and thus meet your OOP. 

Once your OOP is met, the insurance company has agreed to pay 100% of the bill going forward.