Insurance plans can be confusing. We want to help our patients understand their coverage. The following are common insurance terms that explain cost sharing and billing for services.
A dollar amount you must pay annually before certain services are covered under your health plan. This means you may be required to pay all or part of a bill for services, until you have paid your total deductible amount. Some plans may require you to pay coinsurance after you pay your annual deductible.
A limit on the amount of cost sharing that you have to pay annually for covered services. The cost sharing amounts vary by plan. Once you hit this amount the plan pays 100%.
A percentage of the cost of covered services that you must pay after you have paid your full, annual deductible amount.
A dollar amount you pay for certain covered services. The co-payment is due at the time of your visit. Co-payments are always fixed dollar amounts.
Most major insurance companies cover PT services. Before your first visit, it’s best to check your plan’s benefits by calling the member service number on the back of your insurance card or by signing into the portal on the carrier’s website.
Most plans will have either a copayment that is due at the beginning of each visits, or a deductible that needs to be satisfied before they begin paying. When the deductible is met, some plans also require you pay a coinsurance until you reach your out-of-pocket maximum. The deductible and out-of-pocket amount will vary from plan to plan. If you do not have health insurance. We do offer a self-pay rate. Please call us directly to learn more.
HMO plans require a referral from your primary care provider (PCP), this includes some Medicare Advantage Plans. All other plans, such as PPO plans and Medicare do not. Maine is a direct access state. If you have a plan that doesn’t require a referral, you can go directly to PT without seeing a doctor first.
We will file your claims with your insurance company to include workers compensation and liability claims. We do require that you provide us with a copy of your insurance cards (primary and secondary) as well as any other identification numbers necessary for billing purposes. Please be aware that it may take up to 60 days to obtain payment from your insurance carrier.