What Do These Common Physical Therapy Insurance Terms Mean?
Navigating the world of health insurance can be overwhelming, especially when you’re eager to start physical therapy and focus on your recovery.
It’s certainly helpful to understand the key insurance terms that can help you make informed decisions and reduce the stress of managing you or your loved one’s care.
As your neighborhood physical therapist in Providence and North Logan, Reactive Physical Therapy is here to guide you every step of the way. Not only will our team help you understand your benefits, but we also simplify the process by working directly with your insurance company.
[GOOD NEWS: Plus, because Utah is a Direct Access state, you don’t even need a physician referral to begin your journey to better health. A healthier, higher-functioning future can start today!]
Let’s break down some of the most common insurance terms you’ll encounter when starting physical therapy.
What Is a Deductible?
Your deductible is the amount you must pay out-of-pocket for healthcare services before your insurance starts covering costs. For example, if your deductible is $1,000, you’ll need to pay that amount for services like physical therapy before your insurance company begins contributing.
Deductibles can vary widely depending on your insurance plan. Some plans have low deductibles, while others may have higher deductibles but lower monthly premiums. Once you meet your deductible, your insurance usually begins paying for a percentage of covered services.
What Is a Co-Pay?
A co-pay (or co-payment) is a fixed amount you pay at the time of your appointment, even if you’ve already met your deductible. For example, your insurance might require a $25 co-pay for each physical therapy session.
Co-pays are typically listed on your insurance card and can vary for different types of services, such as specialist visits or diagnostic tests.
What Is Co-Insurance?
Co-insurance is the percentage of costs you share with your insurance after you’ve met your deductible. For example, if your plan covers 80% of a physical therapy session and your co-insurance is 20%, you’ll be responsible for paying 20% of the session cost.
Co-insurance differs from a co-pay because it’s calculated as a percentage rather than a flat fee. This amount depends on the total cost of the service.
What Is an Out-of-Pocket Maximum?
Your out-of-pocket maximum is the most you’ll have to pay for covered healthcare services in a plan year. Once you’ve reached this amount (through deductibles, co-pays, and co-insurance), your insurance will cover 100% of your care for the rest of the year.
For example, if your out-of-pocket maximum is $5,000 and you’ve already paid that amount, you won’t have any additional costs for covered services until your insurance plan renews.
What Does In-Network vs. Out-of-Network Mean?
An in-network provider has a contract with your insurance company to offer services at a discounted rate. This typically means lower costs for you.
Out-of-network providers, on the other hand, do not have a contract with your insurance. While you can still receive care, it may cost more, and some insurance plans won’t cover out-of-network services at all.
We’ll Make Sense of Your Insurance Options for You
Once you reach out to Reactive Physical Therapy, we’ll help you verify if your insurance covers our services and explain any differences in costs.
Contact our physical therapy clinic in Providence, UT
Contact our physical therapy clinic in North Logan, UT
Utah Is a Direct Access State: No Referral Needed
In Utah, you can start physical therapy without a doctor’s referral, thanks to the state’s Direct Access laws. This means you can take immediate action to address pain, recover from injury, or improve your physical function without waiting for a physician’s approval.
Direct Access not only saves time but also helps you start your recovery sooner. Our team is here to guide you through this process and ensure you’re supported every step of the way.
How Reactive Physical Therapy Simplifies the Process
We understand that navigating insurance can feel overwhelming. That’s why our team works directly with you and your insurance provider to clarify your coverage, identify your benefits, and estimate your out-of-pocket costs.
Here’s how we help:
We verify your insurance benefits before your first visit.
We explain your deductible, co-pay, and co-insurance so you understand your financial responsibility.
We answer any questions you have about coverage or billing.
Our goal is to make the process as seamless as possible so you can focus on what matters most—your recovery.
Take Action: Your First Step Toward Better Health
Whether you’re new to physical therapy or returning after a break, understanding your insurance coverage is an important first step. Reactive Physical Therapy is here to make that step easier.
Take advantage of Direct Access and start your physical therapy journey now. Let us handle the details while you focus on taking action toward better health. Contact us today to schedule your evaluation at Reactive Physical Therapy, or book your appointment online here.
