What is a deductible?

• A deductible is a dollar amount you pay for your covered medical expenses before your health insurance starts to pay its share. Your health insurance plan determines your deductible, which is reset yearly. For instance, if your deductible is $1,500, you must pay this amount before your health insurance steps in to pay for eligible expenses.

 

What is a copay?

• Copay or copayment is a fixed dollar amount you pay out-of-pocket for covered medical services. This amount varies based on the specific services and is due at the time of service.

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What is a coinsurance?

• Coinsurance is a predetermined percentage you pay after satisfying your deductible. It only applies after you’ve paid your annual deductible in full. You’ll continue to pay coinsurance and copays until you meet the out-of-pocket maximum on your plan — the most you can pay for covered medical services every year. After meeting your out-of-pocket maximum, you are covered at 100%. This does not include monthly premiums, expenses for services not covered by your plan, health care costs above the allowed amount, or out-of-network services.

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How often will I be billed?

• Office copays are due at the time of service. Deductibles and coinsurances are billed after your insurance processes your claims and determines your responsibility. If you have paid another provider your deductible in full, you may be due a refund from that provider since your insurance determined it had not yet been met with ES3PT's claims being processed.

Do I need a prescription?

• Most health insurances require a current prescription/referral in order to begin physical therapy, even if you have a PPO plan. If your policy requires a prescription/referral, you will need to contact your physician to request one. Typically, prescriptions/referrals are current for 90 days unless otherwise specified.

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Will ES3 PT keep track of my plan limits?

• ES3PT can only track your plan and prescription limits for services provided at ES3PT. It is your responsibility to track services received from other healthcare providers outside of ES3PT. If you exceed your plan limits, you are responsible for payment physical therapy services not covered by 
  your plan.

 

What if my plan does not require a prescription/referral?

• If your plan does not request a prescription/referral, California law allows you to be seen for 12 visits and/or 45 days, which ever comes first. After that, you will need to obtain a prescription/referral from a physician in order to continue.

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****As a courtesy, we contact your insurance to verify benefits. Verification is only an explanation of benefits based upon information that we received from your insurance carrier. It is not a guarantee of payment. Please contact your insurance carrier directly to confirm your individual benefits for physical therapy services.

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