Navigating Insurance to Pay for Therapy
Understanding your health insurance plan can be a bit overwhelming and confusing. This post will provide you with some information to help make sense of how medical insurance works and the impact on you when insurance does not pay for everything.
It is important to know that if you get a statement in the mail with a balance that is owed but you were not expecting a fee, you should call the billing department or your insurance company. The following information can impact on the amount that you have to pay for services:
Deductible, what is this?
Not all plans have a deductible, if your plan does, this is the amount you must pay for healthcare expenses before your insurance company starts to pay their share. To find out what your deductible is or if you have one, call the phone number on your medical insurance card. Your insurance company will be able to tell you what your deductible is and how much is left to pay before your services are covered.
Let’s break it down – if your deductible is $2,000, you must pay $2,000 for medical services before the insurance company will start paying their portion.
Copayment, what is this?
Not all plans have copayments, if your plan does, this is a fixed dollar amount you pay for each visit. You are required to pay your copayment when you come for each visit of therapy. To find out what your copayment is or if you have one, call the phone number on your medical insurance card. For
Here’s an example – if your copayment is $25.00 and you come to therapy once per week for a month, you would pay a total of $100.00 of your own money. It is best to pay for a copayment at the time of each visit.
What is coinsurance?
Not all plans have coinsurance, if your plan does, this amount is a percentage of the total cost of each visit that you pay. You and your insurance company split the cost of the visit, some examples are 60/40, 70/30, and 80/20 the bigger number is the percentage your insurance company pays, and you pay the smaller percentage.
What does coinsurance cost? If your coinsurance is 20 percent and the visit cost is $220, you would pay $44.00, and the insurance company would pay $176.00. To find out what your coinsurance is or if you have it, call the phone number on your medical insurance card.
What is the difference between in network and out of network?
Every medical insurance plan belongs to a network of doctors, hospitals, testing labs, and pharmacies. Family Achievement Center belongs to all of the major networks in the twin cities metro area. We work with insurance companies to reduce the cost of your therapy visits and belong to these networks. If your medical insurance provider is considered out of network, you may pay a higher dollar amount per visit. To find out if Family Achievement Center is in network, please call the phone number on your medical insurance card and provide them with our name and if they ask for our NPI it is – 1952411175.
Why are the explanations of benefit letters (EOB) important to review?
Each time you have a medical service; your insurance company will send you a letter explaining how much they paid for the visit and how much your responsibility is to pay. When you get these letters, it is important to open them right away and make sure that the amount you are responsible for paying is right and what you expected. If you have questions about your EOB, please call the number on your medical insurance card, you can also call our billing department at (763) 746-1985 and discuss your concern with our staff. It is possible that the services you are getting here are not covered or eligible to be paid by your insurance company, and the entire amount is your responsibility.
How can I find out if my visits are going to be paid by my insurance company?
You can call the number on your medical insurance card and ask if you have occupational, physical and/or speech therapy benefits. If they require medical coding information, please contact us at 651-738-9888 option 4 and we can provide that information specific to your case.
Family Achievement Center accepts most major medical insurance plans and will send claims for processing to potentially reduce the out-of-pocket cost of therapy. Before starting services, you can call us and we can make sure we accept your insurance, we are here to help. Some of the companies we contract with are:
- Blue Cross Blue Shield
- HealthPartners
- Aetna
- Cigna
- Allina
- Medica
- TriCare
- And many more!
When your insurance changes, it is important to let us know to prevent billing delays. This information is general, and you should always call your medical insurance company with specific questions regarding your individual plan.
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