Simplifying PT Costs: Copay, Co-insurance, and Deductibles Explained
Understanding the financial aspects of your treatments plays an important role in your care journey. Knowing the components and composition of what you’ll be expected to pay can equip you with the knowledge needed to make the best decisions possible as it pertains to your overall health and wellness. We have broken down financial components like co-pays, co-insurances and deductibles, as well as the impact they may have on your PT treatment and care journey.
What is a Co-Pay?
A co-pay is the amount that you pay to cover a specific service. While co-pays can vary depending on your insurance plan and service that you are seeking, it is a fixed amount that is determined each time you go to receive that service. A co-pay is a consistent payment that contributes to the total amount reimbursed by the insurance. Meaning if the insurance company will reimburse $100, the patient pays $40 and the insurance pays $60, hence it’s a ‘copay’ where each person is responsible for a portion of the total reimbursable amount.
What is Co-Insurance?
Co-insurance is a percentage of the cost of a service that is covered by your insurance plan that you are to pay after you have met your deductible. This differs from a co-pay because it is not a fixed amount that is paid regardless of the total cost of the session. What you would pay depend on the costs of the requested services as well as the rate that is determined by your health insurance plan.
What is a Deductible?
A deductible is the amount that you must pay your insurance before your preferred insurer starts to pay for health services. Once the deductible is paid, your only financial concern is to pay the copay or coinsurance that is set by your insurance company. We encourage you to inquire about deductibles before deciding on an insurance company or plan.
Common questions about your physical therapy financials
Now that we have broken down co-pay, co-insurance, and deductibles, we’ve also answered some of the most common questions:
What Happens If I Can’t Afford My Co-Pay?
When investing in your health, we recognize that there may be constraints that can hinder you from receiving the care you need. If you find yourself in a situation where you cannot meet your co-pay, there may be flexibility with your insurance company and they may be able to assist you. In addition, please contact us to let us know and we will work with you as well. This kind of assistance can look like payment plans or financial programs that equip you with what you need to receive the best quality care. There are resources out there to help you manage those costly expenses, so work with your providers and insurance company to find a solution that can work best for you.\
How Does Co-insurance Work After Meeting My Deductible?
Coinsurance is an arrangement between you and your insurance provider to share the cost of physical therapy sessions. You pay a percentage, and your provider covers the rest until you reach the yearly maximum. Contact your insurance provider to help budget for your recovery.
What Services are Typically Covered Before Meeting My Deductible?
Until your deductible is met, you are fully responsible for the costs of your sessions and treatments. However, there may be certain insurance companies who may cover certain services or sessions without having to meet that deductible (e.g. preventative care services). Before assuming the weight of that cost, we encourage you to speak to your insurance provider and your physical therapist for clarity on which services may be covered.
Receive Expert Physical Therapy Care
If you are looking for a physical therapy provider that will work with you to help you meet your unique needs and goals, we are here for you. At Central Virginia Physical Therapy, we are comprised of a team of experts that are committed to delivering quality care to our patients.
