Answers To Your Most Frequently Asked Questions About Insurance Coverage
Frequently Asked Questions About Insurance
Confused by common insurance terms? Not sure how payments work when using health insurance for chiropractic and physical therapy (physical rehabilitation) services? Let us clear up any misunderstandings.
Here are the most commonly asked questions regarding insurance plans, payments, and billing we answer at Ravenswood Chiropractic in Chicago.
What is a Copay?
A copay is a set amount determined by your insurance that you will pay for examinations and/or services you receive at your medical provider’s office. The amount of your copay may differ depending on the type of doctor you see, service you receive or prescriptions you get. Copayments are typically collected at the time of service.
Not sure if you have a copay? Take a look at your insurance card. Copays are typically listed by PCP (primary care physician), Specialist, Emergency Room, and RX (prescriptions). You can always call your insurance company to confirm copays as well.
What is a Coinsurance?
A coinsurance is an amount that you pay based on a percentage of the “allowed fee” agreed to between the provider and your insurance company. The coinsurance is set by your insurance company and they vary greatly between policies. Coinsurances are collected after a provider receives an Explanation of Benefits from your insurance company.
Example: You get an x-ray of your leg and have a 10% co-insurance.
The provider normally charges $150, however because you are in-network the fee that the provider and your insurance company agreed to is $100. Since you have a 10% coinsurance you are responsible for $10. ($150 regular fee -$50 in-network provider discount = $100 | 10% of $100 is $10)
Sometimes but not always a patient can have both a copayment and a coinsurance for a medical visit. This is because some services are subject to a copayment and others are subject to a coinsurance
What is a Deductible?
A deductible is the total amount of money that you need to pay for your health services before your insurance starts to pay for your services. This amount is collected after a provider receives an Explanation of Benefits from your insurance company.
Think of a deductible as a pre-cost requirement for covered services that you need to pay. Once that pre-cost requirement has been met, approved charges will be covered by your insurance company which could be at a certain percentage based on the health plan you are enrolled in.
For example, if you have a $1,000 deductible, you will need to pay $1000 before your insurance will pay your health insurance claims.
Let’s say that once you meet your deductible, your insurance has agreed to pay 70% of all approved medical expenses after that initial $1,000. That means you are responsible for 30% of the expenses after you meet that initial $1,000 deductible.
If you have a $1,500 medical bill. You need to pay $1,000 to meet your deductible. The remaining $500 in medical bills will be covered by your insurance at 70%, which means you will have to pay $150 or 30%.
Your deductible should be listed on your insurance card. If it is not, please call your insurance company to confirm your deductible.
Types of Insurance Plans: HMO vs. PPO
When you choose an insurance plan, you will typically choose between two types of networks: an HMO or a PPO.
An HMO plan requires that you will first have to see your primary care physician (PCP) before you can get any medical services or see a specialist. They make referrals to these services for you within your HMO network as needed.
A PPO Plan gives you the choice to seek specialized care or see any PCP or specialist you want without referral from your Primary Care Provider (if you have one).
In-Network vs. Out-of-Network Providers: What’s the Difference?
All insurance plans have specific rules about visiting doctors that are in-network and out-of-network.
If you visit an in-network provider, your insurance will cover this allowed amount, which is the contracted rate between the insurance and doctor’s office. As far as out-of-pocket cost, going to a doctor in your network is almost always going to cost you less then an out of network provider.
If you go see a provider that is out-of-network, there’s a good chance that your insurance either won’t cover it or will pay a smaller percentage of the medical bill.
In-network and out-of-network benefits can be found in your insurance policy. You can also call your insurance provider to confirm whether out-of-network visits are covered.
What are Covered Services?
These are services that insurance will pay for as detailed in your insurance plan benefits.
Generally, insurance companies will cover Chiropractic Care and Physical Therapy services including TeleHealth but it is always best to call and verify your insurance prior to your visit.
What is Considered a Wellness Visit
A wellness visit refers to any services that are given to keep your health maintained at an optimum level throughout the year. The best example of this is an annual physical exam or yearly check-up in which you do not have a complaint.
Learn more about Wellness Care at Ravenswood Chiropractic
What Type of Insurance Does Ravenswood Chiropractic Accept?
We accept and file for PPO policies for all insurance companies:
• Blue Cross Blue Shield
• United Health Care
• Many other smaller companies
We also accept
• Workman’s Compensation
• Auto Accident / Personal Injury Cases
If you’re not sure whether your insurance is accepted or what services are covered in our office, please give us a call at 773-878-7330 and we’ll be happy to verify your policy benefits with your insurance company and review it with you.