Insurance Coverage Information

We know no one likes surprises when it comes to billing. That’s why we are committed to the following:

After you are evaluated by Jessica, both Jessica and Nichole, will discuss the following with you:

We accept Medicare, workers’ compensation, and most private insurance plans. Please call us for more detail regarding insurance and fees. Our staff will verify and explain your benefits before treatment.

Health Insurance Terms

Here a list of terms that pertain to insurance coverage and payment for health services. Click the terms below for more information.

Co-insurance:

In indemnity, co-insurance is the monetary amount to be paid by the patient, usually expressed as a percentage of charges.

Co-payment:

In managed care, the co-payment is the monetary amount to be paid by the patient, usually expressed in terms of dollars.

Consumer Driven Health Care (CDHC):

This refers to health plans in which employees have personal health accounts such as a health savings account, medical savings accounts or flexible spending arrangement from which they pay medical expenses directly.

Deductible:

The deductible is the portion of medical costs to be paid by the patient before insurance benefits begin, usually expressed in dollars.

Denial:

Denial is the refusal by insurer to reimburse services that have been rendered; can be for various reasons.

Eligibility:

Eligibility is the process of determining whether a patient qualifies for benefits, based on factors such as enrollment date, pre-existing conditions, valid referrals, etc.

Exclusions:

Exclusions are services that are not covered by a plan.

Flexible Spending Arrangements (FSAs):

FSAs are accounts that allows employees to use pre-tax dollars to pay for qualified medical expenses during the year. FSAs are usually funded through voluntary salary reduction agreements with an employer.

Gatekeeper:

in managed care, it refers to the provider designated as one who directs an individual patient’s care. In practical terms, it is the one who refers patients to specialists and/or sub-specialists for care.

Health Maintenance Organization (HMO):

A HMO is a form of managed care in which you receive your care from participating providers.

Health Savings Account (HSA):

HSAs are saving products that serve as an alternative to traditional health insurance. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.

Managed Care:

Managed care is a method of providing health care, in which the insurer and/or employer (policyholder) maintain some level of control over costs and utilization by various means. Typically refers to HMOs and PPOs.

Member:

A term used to describe a person who is enrolled in an insurance plan; the term is used most frequently in managed care.

Open Enrollment:

A set time of year when you can enroll in health insurance or change from one plan to another without benefit of a qualifying evening.

Out-of-pocket:

Money the patient’s pays toward the cost of health care services.

Payer:

The Payer is the party who actually makes payment for services under the insurance coverage policy. In the majority of cases, the payer is the same as the insurer. But, as in the case of very large self-insured employers, the payer is a separate entity under contract to handle the administration of the insurance policy.

Policyholder:

A policyholder is the purchaser of an insurance policy; in group health insurance, this is usually the employer who purchases policy coverage for its employees.

Preferred Provider Organization (PPO):

A PPO is a form of managed care in which the member has more flexibility in choosing physicians and other providers. The member can see both participating and non-participating providers. There is a greater out-of-pocket expense if member sees non-participating providers.

Premium:

Premiums are the cost of an insurance plan shared by employer and employee.

Provider:

The provider is one who delivers health care services within the scope of a professional license.

Reimbursement:

Reimbursementrefers to the payment by the patient (first-party) or insurer (third-party), to the health care provider, for services rendered.

Reference: www.apta.org