New Year! New Insurance? What That Means for You… The Consumer!
It’s the start of a new year which comes with a lot of hopes, goals, and motivation. What is also comes with is a brand-new deductible and insurance costs that we usually forget about. Unfortunately, due to the medical wording and multiple numbers spread throughout the contract, most people do not have a great grasp on what their insurance actually covers and what their costs will be as a consumer. So, let’s break down these concepts so that you can be a more informed consumer.
HMO, PPO, HSA, FSA, etc. Anyone know what these stand for off-hand? If you do know the acronym, do you know what it means in regards to your insurance?
HMO and PPO are your most common plans. These involve a network of providers (doctors, surgeons, physical therapists, etc.) that have a special rate and are often lower cost per visit- as long as the healthcare provider that you seek is in the network.
HSA, also known as a Health Savings Account, is a savings account for money that can be used for healthcare – dental visits, physical therapy visits, yearly check-ups. A business will usually match the amount of money that you add to your HSA each month or some percentage of it. Throughout the year (and your career with the business) you can grow a large sum that is NOT taxed.
FSA, also known as Flexible Savings Account, is similar to a HSA. The biggest difference is that your company will put a lump of money in it at the beginning of the year and whatever is not used in that year goes away.
A deductible is the amount of money that must be paid out of pocket before insurance will cover a percentage. Please note that this percentage is not always 100%. Sometimes, the percentage is 80% or 50% which means that you are responsible for the remaining 20% or 50%, respectively. In addition, some insurance plans have one deductible and some have separate in-network and out-of-network deductibles.
Confused? So are most people – even healthcare providers. Let’s use an example!
Example 1: Corey’s plan has a $3000 in-network deductible and a $5000 out-of-network deductible. He took his New Year Resolution to the max and hurt his shoulder while working out and needs physical therapy. If he chooses an in-network provider he will pay out of pocket until he reaches $3000 then his costs are covered 100%.
Example 2: Larry’s plan has a $2500 deductible and then an 80/20 plan. He began training for a half marathon and hurt is calf. If he chooses an in-network provider, he will have to pay out of pocket until he reaches $2500. After he reaches his $2500 deductible, he will then have to pay the remaining 20% of the healthcare costs. So, if he attends physical therapy at $100/visit, he will still owe $20 each visit AFTER meeting his $2500 deductible.
The average length of stay in physical therapy is about 12 visits. At the usual PT clinic, they likely want you to come in 2-3x/week for 6 weeks. The cost per session could be anywhere from $50-$350 depending on what the PT does with you and how long you are there. On top of that, your PT may be treating between 2 and 4 people at a time. So, technically, this company “takes your insurance” but the payment still comes from your pocket until you reach your deductible ($3000 in Corey’s case and $2500 in Larry’s case).
At Neaux Excuses, transparency is important to us. Unfortunately, due to the murky explanations from insurance companies and the complex healthcare system, people are led to believe that all healthcare visits are a $20 copay.
The reality is, insurance is meant to be used as a failsafe for emergencies – not for consistent care or preventative care. Similar to car insurance, it will help cover costs for a bad accident but, if you need an oil change, that’s on you!
As each new year begins, deductibles are getting higher and benefits are diminishing because healthcare is being over used. This also means that YOU, the consumer, are no longer the priority. Healthcare practitioners are forced to see more patients per day to make up for the decreased reimbursement from the insurance companies resulting in LESS time for you to be face-to-face with the expert. In “usual” physical therapy clinics, you will spend 15-20 minutes with the Physical Therapist and then your care is passed on to a technician or aide. But, are you really getting your monies worth in this deal? You then have to go 3 times per week for at least 4-6 weeks. This means leaving work early, using PTO, finding sitters, etc. multiple times per week!
Why Should You Choose Us Over Your In-Network Providers?
Our visit average per plan of care is less than the national average. In the long run, you will SAVE money.
One-on-one, hour long sessions with a Doctor of Physical Therapy who understands your lifestyle and goals. We have experience in Crossfit, weightlifting, running, gymnastics, dance, baseball/softball, gardening, etc.
Better outcomes than your usual PT clinic.
Care from a provider who thinks outside of the box, encourages input from the patient, and helps establish long-term goals.
Complete transparency with costs and plan of care.
Give us a call today to see how we can help you!