Co-Pay Questions
The Difference Between Co-Insurance and Co-Pay
Co-insurance:
Co-insurance refers to a percentage determined by your insurance plan that you will be responsible for once the insurance company has processed your claim. For example, say your coverage is 90/10, which means you are responsible for 10% of the allowed charges. Therefore, if we ask you to pay $10.00 at each visit, the $10.00 will be applied to your ending balance, which is undetermined until your insurance processes your claims.
Co-pay:
A co-pay (co-payment) is a set dollar amount determined by your insurance plan that is due at each visit. For example, if your insurance plan requires you to pay a $15.00 co-pay, this will be due each time you come for therapy.
Frequently Asked Questions
Q. Will the money I pay at every visit cover all my expenses toward my balance?
A. The money you pay eat each visit usually covers only a portion of your current balance. We expect the balance to be paid by your insurance carrier. However, you will ultimately be responsible for your balance if your insurance doesn’t cover it.
Q. Will I know the exact dollar amount I will be charged prior to treatment?
A. No, our charges will be determined after your first physical therapy or occupational therapy evaluation. You can contact your Patient Service Advocate at 1-866-REHAB ME to discuss any questions.
Q. Will I be responsible for any services my insurance denies?
A. Yes, all services provided must be paid in full by either your insurance plan or you.
Q. Is there a maximum dollar amount my insurance plan will cover?
A. Some insurance plans have a maximum they will pay toward your therapy. You’ll need to check with your insurance carrier.
Q. If there is a maximum dollar amount my insurance will pay for therapy per year and I was treated at another facility before being retreated at SPTRS, will SPTRS be aware of this?
A. No, we are only quoted your benefits pertaining to therapy through SPTRS. We are unaware of prior charges through another facility.
Q. Why did you bill my insurance for something they were not going to pay for?
A. When we verify benefits, we are told your plan coverage only. We are not informed whether any services performed will be denied by your insurance plan.
Q. I thought my insurance covered everything 100%.
A. There may be services not covered under your plan, which can’t be determined until your insurance company has processed your claims.
Q. How much time will I be allowed to pay my portion of the bill once treatment is completed?
A. Contact your Patient Service Advocate to discuss available payment options.
Q. Why does my statement show a credit?
A. All monies paid at time of service are held in your account until your insurance company pays your claims.
If you have any questions about your therapy, insurance or payment options please call Patient Services at 866-REHAB ME or click here to send us an email. We are here to help!