New Year, New Health Insurance Benefits!

With the New Year, most insurance plans start over. This means that there could be changes associated with your health benefits, so the New Year is the perfect time to review your insurance coverage. At Agility Physical Therapy, we want to make sure patients have a full understanding of the costs associated with their visits. Here are some tips to stay on top of the new changes with your insurance:

  • Have a current insurance card with you. This will expedite the process in verifying your benefits.
  • Familiarize yourself with your new benefits. The more you know, the easier the check in process will be at the beginning of the year.
  • Understand that the amount you pay at one office may be different than what you pay at another office. Each office could have different costs depending on the level of care and service provided.

To better understand what your health insurance plan covers, you must first understand the terminology. Here are some common terms to help when looking over your plan:

  • Premium: the amount you pay your insurance company for health coverage each month or year.
  • Health Insurance Deductible: the amount that the patient typically must pay out-of-pocket before the insurance company will begin to pay. For example, if your deductible is $1,000, your insurance will not pay for anything until you have paid $1,000 for services subject to the deductible. Depending on your plan, even if you have met your deductible, you may still owe a copay or coinsurance. In most cases, the lower the premium, the higher the deductible.
  • Out-of-Pocket Maximum: the maximum amount an individual/family will pay for the calendar year for services covered under their health insurance plan (includes deductibles, copays, and coinsurance) until the insurance company pays for all covered expenses.
  • Co-pay: a fixed amount you will pay for a covered health service, as defined by your health plan. Copays usually vary for different plans and types of services. Insurance requires that copay is paid at every visit. In most cases, copays go toward your deductible.
  • Co-insurance: the predetermined percentage of costs you pay to a medical provider once the deductible has been met. In other words, the coinsurance is your share of the total cost for a particular service. Coinsurance amounts very based on each insurance plan. For example, if your insurance plan’s allowed amount for an office visit is $100, you have already met your deductible and you are responsible for a 15% coinsurance, then you would pay $15 at the visit. The insurance company would then pay the rest of the allowed amount for that visit.
  • In-Network: this term refers to medical establishments that deliver patient services covered under the insurance plan. In-network providers are generally the cheapest option for policyholders. Insurance companies typically have negotiated lower rates with the in-network providers.
  • Out-of-Newtork: this term refers to medical establishments not covered under your insurance plan. Services from out-of-network providers are usually more expensive than those rendered by in-network providers.
  • HMO (Health Maintenance Organization) Plan: With an HMO plan, you are assigned a specific primary care provider, and you can then only receive treatment and care from physicians and specialists within the established provider network. Referrals are required for certain providers. Please check with your insurance carrier to see if a referral is required for our facility.
  • PPO (Preferred Provider Organization) Plan: With a PPO plan, you do not have to select a primary care doctor and referrals are not required for specialists.

Remember, your health insurance benefits should be something you use all the time—from yearly check up visits to movement screenings and wellness benefits. Make the most of your plans this year, and make it a happy and healthy 2019!

The majority of insurance plans, including Medicare and private insurers, pay for physical therapy services that are medically necessary. In the state of Colorado, you can go directly to a Physical Therapist under a law that grants “direct access.” This means that, with most insurances, you can visit your physical therapist first without a physician’s referral. With direct access, you can reduce costs with fewer visits to multiple providers, such as your primary care physician or an orthopedic surgeon, for conditions that are affecting your movement. For example, if you were to sprain your ankle or “throw out your back”, you can simply walk into your physical therapists office, who can then diagnose your injury, order imaging to rule out bone fractures or breaks, and begin your plan of care all in one visit.

At Agility Physical Therapy, we are currently accepting all major health insurance plans, with the exception of Aetna no co-pay plans, BCBS Federal and Kaiser non-PPO plans. For a complete list of insurances we accept, visit our insurance page. In addition to accepting most insurance plans, Agility Physical Therapy offers payment plans as well as discounted packages for self-pay rates. For more information or if you have a question regarding whether or not we accept your insurance, contact us at agilityphysio.com or 303-773-0771 and we will verify your benefits for you.