When choosing to do self-pay or insurance, here are some facts and figures that may help you choose the best plan for you and your healthcare:
Self-pay Visit Insurance Visit
|Initial Evaluation Cost - $110||
Initial Evaluation Cost - $300
|Follow Up Visit Cost - $75/visit||
Follow Up Visit Cost - $300/visit; When billing insurance, we adhere to your insurance's agreed fee structure. You may see a difference in what is actually billed for a service and what your insurance company negotiates for coverage. (Roberts and Associates Physical Therapy is our contracted provider for insurance billing).
|No limits on PT visits||
Depending on your insurance plan, you may have limited visits to use per calendar year for PT/OT and other therapy
|Direct Access - no MD referral necessary to initiate care||
Depending on your insurance plan, you may need a referral from your physician prior to physical therapy treatment. We are more than happy to look into this for you, if you can please call and provide Dynamic your insurance information.
Terms to know on your insurance plan to make an informed decision of self-pay vs insurance:
- Deductible: The amount of money you must pay out-of-pocket before coverage kicks in. Deductibles are usually set at rounded amounts (such as $2,500 or $5,000). If the patient has procedure performed for $500 and the deductible is not met, the patient is responsible for $500 in costs.
- Coinsurance: The amount of money you owe to a medical provider once the deductible has been paid. Coinsurance is usually a predetermined percentage of the total bill. If the policy’s co-insurance is set at 20% and the bill comes to $100, the policy-holder owes $20 in co-insurance.
- Co-pay: This type of insurance plan is similar to co-insurance, but with one key exception: rather than waiting until the deductible has been paid out, you must make their copayment at the time of service. Most often, copayments are standardized by your plan, meaning you’ll pay the same $30 each time you see a health care provider. If you have not met your deductible, you will be responsible for the cost of the whole visit.
- Out-of-pocket maximum(OOP): The amount of money you pay for deductibles and coinsurance charges within a given year before the insurance company starts paying for all covered expenses. Out of pocket maximum range from $5,000-$10,000. Once the patient has reached the OOP amount, insurance will usually pay 100%.
If you are interested in using your insurance for physical therapy at Dynamic, please call our front desk staff at 608.351.3049 to verify your benefits and eligibility and to schedule your appointment.
If you are interested in going the self-pay route, you can access our online scheduling system here or give us a call at 608.351.3049.
Our Dynamic therapy team looks forward to keeping you moving!