Insurance Frequently Asked Questions

In-Network vs. Out-of-Network Care (INN vs OON)

In-network care refers to services provided by physical therapists who have partnered with your insurance company. Physiologix has established contracts with several insurance providers, offering you the advantage of lower out-of-pocket costs. Our therapists have been carefully vetted by these insurance companies, ensuring their qualifications and expertise.

Out-of-network care allows for a personalized approach to your treatment and quicker recovery. At Physiologix, we believe in providing the highest quality of care tailored to your specific needs. Our out-of-network services grant us the flexibility to offer specialized treatment approaches and prioritize your individual goals, free from the limitations imposed by insurance contracts.

Deductible

A deductible is the amount you are required to pay out of pocket before your insurance coverage begins. For example, if your plan has a $500 deductible, you must pay the first $500 of covered services before your insurance starts sharing the cost. Deductibles are assessed annually, typically at the beginning of the plan year. While most plans reset on January 1st, it's important to review the specifics of your plan as the plan year start date may vary based on your insurance provider. That is something that our insurance verification team can help you with as well as we provide you with the most detailed explanation regarding your benefits check so you are in the loop constantly.

Coinsurance vs. Copay

Coinsurance and copay are both forms of cost-sharing between you and your insurance company.

Coinsurance is a percentage of the total cost of a service that you are responsible for paying, even after you have met your deductible. For instance, if your insurance plan has a 20% coinsurance rate, you will be responsible for paying 20% of the cost of each visit or service, while your insurance covers the remaining 80%.

A copay, on the other hand, is a fixed amount you pay at the time of each visit or service. Unlike coinsurance, copays are not based on a percentage but rather a predetermined flat fee. Copays are often seen in insurance plans with more predictable and standardized healthcare costs.

Out-of-Pocket Maximum (OOP Max)

The out-of-pocket maximum (or limit) is the maximum amount you are required to pay for covered services in a given year. Once you reach this limit, your insurance plan will typically cover 100% of the costs for the remainder of the year. It includes deductibles, coinsurance, and copays. Out-of-pocket maximums provide financial protection by capping the amount you have to spend, ensuring that you are not burdened with excessive expenses.

Allowed Visits

Some insurance plans have limitations on the number of visits or therapy sessions they cover per year. These allowed visits, sometimes referred to as visit limits, can vary depending on your specific plan. Physiologix can assist you in understanding your plan's allowed visits and help you optimize your treatment within the covered limits.

The PhysioLogix Difference

At Physiologix, we are committed to providing you with the highest quality of care while ensuring we offer a range of financial options. We understand that maximizing the value of your physical therapy services is important to you. That's why we offer flexible treatment options, including 30-minute, 45-minute, and one-hour sessions. We also provide package discounts to help you get the most value from our services.

We strive to deliver exceptional care that addresses both your healthcare needs and financial considerations. Our goal is to support your recovery journey and empower you to achieve your optimal physical well-being.

If you have any further questions or need clarification about insurance-related topics, please feel free to reach out to our team. We are here to assist you and provide the guidance you need to make informed decisions about your physical therapy treatment.