How does my health insurance actually work?

How does my health insurance actually work?

By Lillian Wynn, PT, DPT 

Health insurance can be a very confusing and complicated thing to navigate. We try very hard to work with all of our patients to understand what their coverage is so we can be honest up front with how much PT will cost you.

This is by no means a complete list of everything you need to know, but we are hoping it will help answer some of your questions about how things work.

Health Insurance Premium

This is the amount of money that you pay to your insurance company every month to buy coverage. The amount varies depending on which health insurance company you have, how much coverage you are paying for, and how many people you are paying for.

Network

Health insurance companies and health care providers also sign contracts with each other to determine if you are ‘in network’ or ‘out of network’. Oftentimes your coverage is different depending on whether you are in or out of network

Health Insurance Deductible

Not everyone has a deductible. This is the amount you must pay ‘out of pocket’ before your insurance starts helping pay for things. How much deductible you have varies depending on which health insurance company you have, how much coverage you are paying for, and how many people you are paying for. If you have a high deductible plan, you often qualify for a Health Savings Account (HSA).

Co-pay

This is the amount that you owe out of pocket at each doctor’s visit. This is IN ADDITION to your monthly premium. If you have a deductible, this may still apply after your deductible has been met. The amount of your copay depends on which health insurance company you have, how much coverage you are paying for, how many people you are paying for, and which type of doctor you are seeing.

I still have questions about:
  • My premium
  • Which plan I have
  • Whether I qualify for an HSA

Please call your health insurance company at the number on the back of your card

I still have questions about:
  • If PT First is ‘in network’
  • If I’ve met my deductible
  • What my co-pay or out of pocket cost is
We can help, feel free to give us a call!