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Dealing with a High Deductible Health Plan (HDHP)

It’s a new year, and if you’ve set health-related resolutions, you can’t afford to be sidelined by aches and pains. It’s time to get checked out by your physical therapist!

Booking your first appointment after switching health plans or a deductible reset can be scary. Trust us – we get it! The good news is our scheduling team and billing concierges are experts at sifting through the intricacies of your health plan’s fine print. We’ll distill all the jargon down until you’re left with exactly what you need to know before your first visit, so you’re not blindsided by anything.

Below, we’ll be answering some of the most commonly asked questions about insurance, deductibles, and physical therapy, BUT if you’ve still got questions after reading or are curious about the specifics of your plan, reach out… we’re here to help!

Is physical therapy covered by insurance? If so, how much will they pay, and how much will I owe?

Yes – most insurance plans cover physical therapy, and we are in network with most insurance companies. However, there are always exceptions, and every health plan is different. Before your first appointment, we’ll verify your plan details with your insurance provider and give you the official rundown.

As for how much you’ll pay, again, it varies by plan. We’re not trying to be deliberately obtuse, but we can’t answer this one in more detail without the specifics of what your health plan entails. Some may have copays, or fixed fees, which are due at the time of the visit. A typical copay for a routine visit or wellness check is $15 to $25; $30-$50 for a specialist; $75-100 for urgent care; and $200-$300 for an emergency room visit. Others may be responsible for coinsurance, or a percentage of the bill.

Rest assured, we never want you to show up for a visit and be caught off guard about what you owe. When we book your appointment, we’ll dig deeper into this to find out exactly what your deductible, copay, and/or coinsurance may be. Alternately, if you’d like to do some research yourself, you should be able to log into your insurance provider’s website or call the number on the back of your insurance card to get the specifics.

What if my preferred PT is out of network – can I still see him or her?

Most insurance companies (excluding Medicare and certain HMOs) allow members to go “out of network” for health care services, meaning that you can still see your physical therapist, though you may be responsible for more of the bill.

Again, we are in network with most insurance companies, but we will inform you prior to your visit if that is not the case.

Do I have to see my doctor first? Am I skipping a step by going to PT first?

No. In fact, the PT first route is highly recommended if you live in a direct access state! If your first stop is your primary care physician, they will likely refer you to an orthopaedic specialist, who would then send you for physical therapy. Given that the average wait time to see a physician or specialist is 24 days, that process alone could set you back several months. Why delay when you could go straight to the source? We’ll get you into a clinic near you within 24-48 business hours!

Worried about getting a correct diagnosis from your PT? Don’t be. Your physical therapist can diagnose musculoskeletal injuries with the same amount of accuracy as an orthopaedic surgeon. And – if you’re still skeptical – the vast majority of patients see an improvement within 2-3 visits. So, you should know pretty quickly whether or not you’re in the right place! If it turns out you aren’t, we’ve got a great network of specialists we refer to and can connect you quickly with the right one.

I’m pretty clear on my plan specifics, and I know I’m not anywhere near hitting my deductible yet this year. I want to see my PT, but I’m not sure I can afford it. Any tips?

Reach out. We are committed to providing our patients with the highest quality care, and that doesn’t just mean on the treatment table – we’re always searching for options to make physical therapy a reality for our patients, regardless of their financial situation. Thus, we offer a variety of affordable payment and financing options, including:

FLEXIBLE SPENDING ACCOUNTS (FSAs) & HEALTH SAVINGS ACCOUNTS (HSAs)

When you’re looking into your plan details, be sure to check whether or not you have a Flexible Spending Account (FSA) or Health Savings Account (HSA) set up.

FSAs & HSAs are great options for those looking to use pre-tax dollars to pay for medical procedures. Flexible Spending Accounts are set up through your employer and must be used by the end of each enrollment year, though some programs may have a short grace period once the year has expired. Don’t let those dollars go to waste!

Health Savings Accounts allow you to spend money on qualified health expenses or medical costs not at all covered by your insurance. Unlike FSAs, there is no deadline for withdrawing funds and anyone can set up an HSA.

Another bonus? Our therapists are specialists, not generalists, which means you get results in fewer visits, saving you both time and money. And, getting started with physical therapy sooner than later has been proven time and time again to be more cost effective than waiting

The bottom line: don’t suffer with pain any longer because you’re worried about the cost. Instead, give us a call – we’ll work with you directly to come up with a payment plan that suits your needs.

That’s great info. Thanks! How do I schedule?

It’s easier than ever to make an appointment with us… call, text, or chat with us to get started!

Still have questions about your benefits or what you might pay for a visit? Reach out! We’re always available to talk and we’ll work together to make sure you get the care you need, regardless of your financial situation.

Click here to find your closest physical therapist clinic and schedule today.

* All plans are different – contact your insurance provider for details on eligibility and benefits. *

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