Understanding Different Insurance Plans + Policies
What is health insurance exactly? It’s talked about a lot — but how does it really work and why do we need it? Here’s a simple way to look at it: Health insurance is a plan, or policy, that covers a percentage of doctors’ visits and hospital bills. It exists to help offset the costs of medical events, whether they’re planned or happen unexpectedly. Health insurance may also protect us when we’re feeling good — and may help keep us feeling that way — through wellness programs and preventive care.
How does health insurance work? - Health insurance is a contract between you and your insurance company/insurer. When you purchase a plan, you become a member of that plan, whether that’s a Medicare plan, Medicaid plan, a plan through your employer, or an individual policy. At Dynamic, we take most insurances. Some of the common insurance programs we accept are:
Anthem Blue Cross Blue Shield
Arise Health Plan/WPS
HealthNet Federal Services
When choosing to utilize your insurance benefits for your appointment at Dynamic, there is some extra information that we will need to gather from you, before your appointment, to verify what the benefits of your plan are and what the cost to you will be to be seen by one of our providers. If you schedule over the phone, we will ask you for the information immediately. If you choose to book online, one of our Patient Care Coordinators will be in contact with you to get the information.
All the information that we need should be located on your insurance card(s). If you have a secondary or supplementary insurance, we will need this information for that as well.
Primary Insurance Name
Policy Holder's Name
Provider Services OR
Member Services Phone Number
Once we have this information, one of the patient care coordinators will call and get the specifics of your plan.
Some of the Common Insurance Terminology we use is:
Deductible: The amount of money you must pay out-of-pocket before coverage kicks in.
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.
Copay: 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. This is usually a set dollar amount.
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.
Visit Limits/Used Visit: The number of visits a policy will allow a patient to have in a plan year.
Prior Authorization: Prior authorization means getting approval before getting access to services. A decision has been made by your health insurer or plan that a service is medically necessary. With Prior Authorization, your health insurance agrees to pay for the service.
Referral: Many insurance plans require a doctor referral, this is a statement, authorized by your practitioner recommending Physical Therapy.
Dry Needling: This is a type of treatment commonly used by our therapists. Dry Needling is not covered under insurance benefits. If you are utilizing insurance benefits, and the therapist uses dry needling as a treatment, you will be charged a $25 dry needling fee, in addition to any insurance costs.
Since every health plan is different, we will make sure you are given the specifics of your plan before your appointment, such as how much of your deductible has been met, so that you can make an informed decision about whether you would like to utilize your insurance benefits.
Insurance appointments will cost between $300 to $400 a visit. This price is set by the insurance companies themselves and they require Dynamic to charge what they set the appointment price to be. Insurance patients are responsible for 100% of that cost until the deductible on their insurance plan is met. After the deductible is met, the co-insurance or co-pay of the plan will start.
In some situations, it can be less expensive to utilize our self-pay option, than to go through an insurance provider. That is why we offer cash-based affordable flat rates. No referral needed and no surprise costs. For this option, many patients will use a Health Spending Account, or Flex Spending Account. We also take cash, check, and credit cards.
At Dynamic, we take most insurances. However, depending on your insurance plan, we may fall in or out of network. Most patients can get “out of network” reimbursement for their treatment. This process is similar to other forms of insurance, such as car insurance.
If you are looking for help with a current musculoskeletal problem or are looking to make safe changes in your fitness and health, Dynamic Performance and Therapy is an affordable option for you to do so.
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