Understanding Your Health Insurance
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[/et_pb_text][et_pb_text admin_label=”Text” _builder_version=”3.0.74″ background_size=”initial” background_position=”top_left” background_repeat=”repeat”]This post is way overdue. It’s something I’ve been wanting to discuss for some time now but haven’t gotten around to doing. I see too many people on a daily basis who have no idea how their health insurance works. People need to be informed about how the current medical model is set up.
Health Insurance Terminology 101
Have you ever gone to a healthcare appointment thinking your health insurance was going to cover the service, and then received an unexpected bill in the mail?At PhysioStrength, that will NEVER happen. We charge a flat fee for our services. This means no hidden bills or charges. However, we still get asked questions about certain key words related to health insurance. Here is some information about key terminology used in your insurance plan.
Deductibles: The deductible is the total amount you must pay out of pocket before your health insurance starts to kick in. For example, if you have a deductible of $1,500, that means that your insurance will not pay for anything until you have spend $1,500 out of pocket for services. Even once you’ve met your deductible, most insurance plans still require you to pay a copay or coinsurance amount for each visit. This means that at the beginning of each year, you will always be paying out of pocket for healthcare services until you’ve met your deductible.
Co-Pays: A copay is a fixed amount that you are responsible for at each visit. Different plans have different co-pays but most range from $20-$50. In most cases, copayments go toward your deductible. At PhysioStrength, we don’t require co-pays because we already charge a flat rate.
Co-Insurance: Co-insurance is a calculated percentage that you are responsible for paying. Many plans have a 80/20% coinsurance that only applies once you have already met your deductible. A 20% coinsurance means that you are responsible for 20% of the total cost (after the deductible has been met). For example, let’s say:
- You go to the doctor and the charge is $200
- You have already met your deductible
- You are responsible for a 20% coinsurance.
In this scenario, you would be required to pay $40 at the time of service, and your health insurance company would cover the rest of the cost for that visit.
Hopefully these definitions help shed some light on what is expected of you with regards to payment for healthcare services.
Do You Understand How Your Health Insurance Works?
Does your insurance company have your best interest in mind? No.
The multi-billion dollar healthcare insurance industry wants to regulate your care. Insurance companies are businesses. When you use your health insurance, the insurance companies lose money. Therefore, the goal of the insurance companies is to do everything in their power to minimize how much care YOU receive. Each time you use your insurance, they lose money. That is why each year, they put new rules and regulations in place. Insurance companies want to be able to control how clinicians treat patients so that overall visits are minimized. When it comes to services like physical therapy, chiropractic, and imaging services such as MRI and X-ray, the insurance companies will do everything in their power to minimize costs. They often require pre-authorization visits for imaging services, even when the services are clearly indicated. At PhysioStrength, we don’t believe in compromising quality of care for the benefit of insurance companies. We don’t like our patients to have to jump through hoops to get the care they need and deserve.
Here at PhysioStrength, we have chosen to opt out of the insurance game so that we can provide you with the best quality care without being subjected to constraints put in place by health insurance companies. Although we do not directly bill insurance, many of our patients still get reimbursed for our services. For more information on how to get reimbursed by your insurance company, read our Insurance and FAQ page.
How Insurance Regulates Healthcare
The current medical model is causing healthcare providers to change the way they treat patients based on reimbursement from health insurance companies. Does every patient really need to be seen by a physical therapist or chiropractor three times per week? No. In some instances, frequency of services and continual care is very important. However, not every patient with minor aches and pains needs to be seen by their provider three times per week. Now, don’t take this the wrong way. There are instances when patients should be seen multiple times per week. In certain post-surgical instances or in certain athletic populations, this can be very beneficial. However, not everyone needs this. Many practitioners are forced to base their care on what gets them paid. Many healthcare providers are forced to upsell their services in order to make a profit because of insurance reimbursement. Not PhysioStrength. We do things differently.
Why PhysioStrength Does Things Differently
We treat active individuals. We work with people who value their health and want to get better.
PhysioStrength is purposefully an out of network provider so that we can provide better quality care. Although our patients CAN still get reimbursed for our services, we are not subject to the tight rules and regulations of health insurance companies. This allows us to devote more time to you, our patients. This allows us to not have to upsell you or try to convince you that you need more care than you do. We are able to be honest with our patients because we aren’t regulated by a middle man.
Please don’t hesitate to contact us and see how we can help you today!
PhysioStrength Physical Therapy
2909 S. 12th St. Tacoma, WA, 98405
Phone: (253)-722-9788
Fax: (253)-778-6992
cnaccarato@physiostrength.com[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section]