Do you feel like your insurance coverage gets more confusing each year? That’s probably because it does! It seems like each year there is another rule or exception to your plan but the cost keeps going up. Here at Jade, we are often asked, “how much will this cost?” The answer isn’t as easy at it seems.

Every insurance plan has different stipulations and different guidelines and no two are alike. There are several different types of plans that will include a deductible, coinsurance, co-pay or all of the above depending on the service. Years ago we used to only see co-pays for an office visit, but the cost of insurance premiums have increased drastically as well as deductible plans becoming the norm.

ALL ABOUT DEDUCTIBLES

When you have a deductible plan this means that you are responsible to pay out of pocket the cost of each visit/service until you have paid your deductible in full.

For Example: Molly has a $3,000 deductible and a 20% coinsurance. This means that she will be paying for ALL of her healthcare visits (aside from preventative care for most plans) out of pocket. Once she has paid $3,000 total toward healthcare visits, she will then be responsible for 20% of the cost of a visit. Your insurance will pay for the rest.

Therefore, if you hear, “yes, your insurance covers this” it doesn’t always mean your insurance is paying for it.

COPAYS

If your insurance has a co-pay plan this means, you will have a flat rate for each visit. Typically you will have a co-pay and a specialist co-pay. Specialist co-pays tends to be a little higher in cost. This will include seeing any type of specialist.  

Out of Pocket: This is the maximum amount of money you can expect to pay out of pocket for healthcare costs before your insurance pays in full. An Out of Pocket applies to deductibles, coinsurance and co-pays.

For example: Molly has met her $3,000 deductible but now she is responsible for 20% of her services. Her Out of Pocket maximum is $4,000. She has already paid $3,000 towards her deductible so she has $1,000 left in expenses, but she is now paying a lesser amount for each visit.

FAQS

How much will my physical therapy and/or acupuncture visits’ cost if I have a deductible?

This is also a not-so-easy answer. This is all dependent on what services are performed at each visit and what is contracted between the insurance and provider. There are some charges that are billed for time (timed codes) and others that are billed for a certain procedure, regardless of how long it took (untimed codes).  Your provider should be able to give you a ballpark estimate of how much each session will cost.

Is Acupuncture covered by insurance?

More plans are beginning to cover acupuncture but it’s important you read your summary of benefits to make sure, or have your provider call and check for you. Some plans will cover acupuncture, but only with certain diagnosis codes. Some plans have no restrictions at all!

At Jade Integrated Health, we always make sure that you understand your insurance coverage following your first appointment. We know that healthcare can be expensive and we never want that to stand in the way of your care. For those who qualify, we can offer financial support through payment plans. If you ever have questions regarding coverage for physical therapy or acupuncture, give us a call today. Our front desk will be happy to assist you.