How Much Will Physical Therapy Cost Me?

 In Business, Education

Many patients are fearful to ask the question, “How much is this going to cost me?” Sadly, the answer is not as easy and straightforward as we all would like. Different insurance carriers and different plans offered by those carriers along with what individualized treatments and services are needed to resolve a patient’s issue all play a factor in payments owed to your medical provider. The “easy” answer is – it depends. Are you self-pay or do you have a deductible, co-insurance, or co-payment, and have you met your out-of-pocket maximum?

WHAT?!

All patients will have a payment responsibility linked to at least one of these four payment types. For specific details regarding your responsibility, you may want to contact your insurance provider directly. However, we have attempted to make the information a bit easier to understand here:

  • Self-pay: This is exactly what it sounds like, and you are responsible to pay for the full amount (100%) of your bill based on treatments received and services rendered. This is mostly applicable to patients who do not have insurance coverage or who prefer to submit reimbursement requests to their insurance company. Here at PT South, we will submit claims to your insurance company on your behalf unless you ask us not to and choose self-pay.
  • Deductibles: Most insurance plans include a deductible that has to be met before the insurance will cover any costs. For some patients this could be a very low amount, but for others it could be a very high amount. It is solely based on what type of insurance plan that patient has but is applicable across medical providers and not specific for each medical provider. An example would be that you are responsible for paying $750* towards medical services and then your insurance company will contribute to the bills from your medical services.
  • Co-Insurance/Co-Payment: Many insurance plans include either a co-insurance or a co-payment. A co-insurance is a PERCENTAGE of the overall billing for each visit and can vary based on medical services received. An example would be an 80/20 plan* where the insurance company covers 80% of the bill and the you are responsible for 20% of the bill. A co-payment is a FLAT RATE for each visit and does not vary based on medical services received. An example would be a $40 fee* for each office visit.
  • Out-of-Pocket: This dictates how much money a patient may have to pay before insurance covers all claims at 100%. An example would be that you have a $500 deductible* to meet before the insurance carrier will cover 80% of bills and you will continue to pay your 20% co-insurance*. The out-of-pocket max for you is $1,000* so once you have paid the additional $500 towards your co-insurance your will have met your out-of-pocket max and your insurance carrier will now cover 100% of your bills.

 

*All figures are hypothetical and intended for illustrative purposes only. Please contact your insurance provider directly for your specific responsibilities and the figures associated with them.

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