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  • Writer's pictureAmanda Shultz

Billing 101

With the start of each new year, many questions pertaining to insurance surface. Do you ever wonder what all those insurance terms you hear at the front desk of medical offices mean? Do you know why you have to sign new insurance forms every year?

Let’s start with the basics of insurance terminology:

o Deductible: this is the amount you’re required to pay before insurance will “kick in.” Think of it like car insurance; if there is $1000 worth of damage to your car, you'll file a claim with your car insurance company. If your plan has a $500 deductible, you’ll need to pay the first $500 before insurance will pay the remaining balance.

o Copay: a set dollar amount which you’re required to pay per visit, after any applicable deductible has been met. The insurance company covers the remaining balance of the visit, after you pay your copay.

o Coinsurance: a percentage of each visit you’re required to pay, after any applicable deductible has been met. If you have 20% coinsurance, insurance pays 80% of each visit and you are responsible for the remaining 20%.

o Out of Pocket Maximum: The maximum amount of money per plan year you will have to pay TOTAL, before insurance covers services at 100%.

Keep in mind that your deductible and out of pocket amounts cross accumulate with other medical visits outside of our facility. Meaning that if you have lab work for example, the amount billed may also chip away at your deductible and out of pocket.

Now that we’re all familiar with the terms, let’s get into those forms. Trust us, it’s not fun for us either. Every year, whether it’s January or the month that your health insurance contract renews, your benefits reset. Here at Lynch Physical Therapy, there’s a team of people whose job is to check and verify patient's benefits. We record what we are quoted by a representative from your insurance company, update your information, adjust your responsibility and confirm visit you’re not hit with unexpected charges down the line.

We always encourage you to check with your insurance company, so you have the best possible understanding of your plan’s coverage. We’re happy to help as well; if you have any questions, don’t hesitate to contact our billing department at (410) 960-1601 ext. 2.

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