Understanding Insurance Deductibles, Co-insurance, and Co-payments: A Guide for Parents at Children In Motion Therapy Clinic

Navigating the world of health insurance can be challenging, especially when it comes to understanding terms like deductibles, co-insurance, and co-payments. At Children In Motion, we believe in empowering our families with knowledge to help them make informed decisions about their children’s care. Here’s a simple breakdown of these terms and how they apply to therapy services such as occupational and speech therapy.

What is an Insurance Deductible?

An insurance deductible is the amount you pay out-of-pocket for healthcare services before your insurance plan starts to pay. For instance, if your deductible is $1,000, you will need to pay the first $1,000 of the covered services yourself. After you have paid your deductible, you usually pay only a co-insurance or co-payment for covered services, and your insurance covers the rest. It’s important to note that co-pays do not contribute towards your deductible.

Co-insurance vs. Co-payment: What’s the Difference?

Co-insurance is typically a percentage of the cost of your child’s therapy that you pay after meeting your deductible. For example, if your health insurance plan’s co-insurance rate is 20%, and the therapy session costs $225, you will pay $45 while the insurance pays the remaining $180.

Co-payment, or co-pay, is a fixed amount you pay for a healthcare service, usually when you receive the service. The amount can vary by the type of covered healthcare service. For example, it might be $30 for a standard session of speech therapy, regardless of the total cost of the visit.

Family Responsibility for Uncovered Amounts

It is important to understand that families are responsible for any amounts not covered by insurance, as deemed appropriate by the insurance company. This includes costs exceeding your co-payment or co-insurance after the deductible is met. For a clearer understanding of what is covered, we highly recommend that parents call their insurance company to verify benefits for the services at our clinic before beginning therapy.

Limitations on Therapy Sessions

Most insurance companies set a limit on the number of therapy sessions for occupational and speech therapy that they will cover each plan year. It’s crucial for families to be aware that many insurance companies will not approve additional sessions beyond this limit. Understanding these restrictions can help you plan your child’s therapy sessions more effectively and avoid unexpected costs.

How Do These Costs Affect Therapy at Children In Motion?

When you schedule therapy for your child at our clinic, the billing process starts with our administrative team verifying your insurance coverage, including your deductible, co-insurance, co-pay details, and session limits. Understanding these terms helps you anticipate potential out-of-pocket costs. Here are a few tips to manage and understand these costs better:

1. Keep Track of Deductibles: Keep a record of your healthcare expenditures to know when your deductible is met. This can help you plan therapy sessions more effectively.

2. Budget for Co-pays and Co-insurance: Since these costs occur each time you receive a service, setting aside a budget for these regular expenses can prevent surprises.

3. Understand Your Coverage Limits: Be aware of how many therapy sessions your insurance covers annually and plan accordingly.

4. Call Your Insurance Company: The best way to understand your insurance coverage is to call Member Services and ask questions about your plan, your deductible, what is and is not covered under your plan. The insurance company sets all of the rules around reimbursement, what you will pay, and what they will cover. So, reaching out to them with questions is always your best bet.

5. Speak to Our Team: If you have any concerns about billing or insurance, our dedicated staff are here to help. We can assist in explaining your benefits and navigating coverage details.

Questions About Coverage, Bills, and Explaination of Benefits

1. Call Your Insurance Company First: When Children in Motion charges you any amount after billing your insurance, we only ever bill the amount that your insurance tells us we have to charge you. Your insurance company dictates:

   1. How much you will pay for your sessions: Your insurance company issues an Explaination of Benefits (or EOB) which you have access to in on your Insurance Carrier’s website. The EOB is also sent to Children in Motion and it tells us exactly what to charge you for your sessions. Children in Motion does not have any control over your insurance carrier nor their determination on services.

   2. How many sessions of therapy your child is allowed in a plan year: Parents should know that in many cases Occupational, Physical, and Speech Therapy services may be combined in a plan. Therefore, if your child is receiving Occupational and Speech Therapy services, you will run out of sessions faster.

2. What if My Insurance Denies Payment?

   1. If your insurance denies payment, then you are ultimately responsible for the billed amount out of pocket. Children in Motion cannot guaruntee that your insurance company will cover any services. Therefore, you must speak with Member Services to find out why the services were not covered.

   2. As a member, you have the right to appeal any decision made by your insurance company. Children in Motion is always happy to provide documentation to families who are filing an appeal with their insurance company. However, we ask that you file the appeal as you are the member of the insurance plan.

Conclusion

At Children In Motion, we understand that dealing with insurance while caring for your child can be complex. We hope this explanation of deductibles, co-insurance, co-payments, and session limits helps you navigate your insurance policy better. Remember, our team is here to support you through this journey, ensuring your child receives the best possible care without unnecessary financial stress.

For more detailed information, please reach out to your insurance provider directly. You can always find the phone number for Member Services on the back of your insurance card.