Welcome to the Dynamic Edge Physiotherapy blog!
Once a month we will be posting about a new topic that you may have questions about. Our topic this month is.... HEALTH INSURANCE! Health insurance can be a really confusing topic, but it is extremely important that you understand what your plan covers in regards to your coverage and benefits. We will be discussing some of the most common key terms, what they mean, and how they vary depending on your plan.
First things first, not every plan is exactly alike. Plan coverage is dependent on a multitude of factors. When choosing an insurance plan along with paying for a monthly premium, there are other costly factors to be aware of; your deductible, whether or not you have a co-pay or co-insurance, and your out-of-pocket stop loss. For the sake of this blog we will use this example: The “patient” has a $2,000 deductible, 15% coinsurance, and $4,000 out-of-pocket stop loss. They also have a health savings account, which we will talk about later.
First, we will discuss deductibles. Deductibles are relatively universal across the insurance world, as most plans will require a deductible for any medical service. Before the insurance will pay for anything you will be responsible for any medical costs within your deductible, and that amount can range from between $0 to $5,000+. Depending on your monthly insurance premium (the amount of money you pay for the insurance policy) the deductible may be higher or lower. Often times the higher the premium, the lower the deductible. Using our “patient’s” deductible as an example, they are responsible for paying $2000 worth of medical expenses before their insurance will contribute payments. This will include all medical procedures and visits ranging from yearly check-ups to MRI’s X-ray’s, etc.
After you have reached their deductible, the cost per visit will decrease as well. Depending on whether the insurance policy includes a co-pay or co-insurance, you will be responsible for paying a percentage of the medical costs. In our example, our patient has a 15% co-insurance. This means they have to pay 15% of the contracted rate between the provider and the insurance company. If the contracted rate is $100 per visit, then the patient has to pay $15, and the insurance company