How to get the best out of your health insurance.
Three questions to ask when buying health insurance to optimize your rehabilitation:
As a mission-driven organization, our goal at Sea Pines physical therapy is to improve the health of our community. To allow access to care for as many people as possible, we accept most major health insurance plans. We are passionate about helping people and wish to remove barriers to achieving optimal health, including the financial burden of receiving medically necessary rehabilitation. Unfortunately, our insurance-based healthcare system has faced challenges over the last few decades including a significant increase in the cost of health insurance. For example, the average monthly premium on the Washington State Health Benefit Exchange has increased from $295 per month in 2014 to $628 per month in 2024. Read more here.
Meanwhile, many insurance companies have posted record year-over-year profits, exemplified by United Health Care’s $22 billion profit in 2023.
To achieve these financial results many health insurance companies have put complex limitations on their coverage for care. When choosing a carrier and plan, we advocate asking the following three questions to lower your probability of having limited insurance coverage for your rehabilitation.
#1 Is pre-authorization required for physical therapy services?
A common practice by insurance companies is to advertise a high number of physical therapy visits covered per plan year, however, you may not be able to access those visits if the plan requires pre-authorization for coverage. Pre-authorization requirements are burdensome for providers, lead to delays in care, and can lead to non-payment. Choosing a plan that does not require pre-authorization for physical therapy can help you avoid those issues. For more information on the cost of pre-authorization, see this excellent piece by the New York Times.
#2 Is my Physical Therapist in-network?
Many insurance companies pay providers less today than they did 10 or even 20 years ago. The rising cost of living has put providers in a tough position of either continuing to accept insurance at a financial loss or limiting their acceptance of certain insurance companies. At Sea Pines physical therapy, we are proud to accept most major insurance plans. If we do not accept your insurance we encourage you to pay at the time of service by offering a $95/per hour rate for our services.
#3 What is the deductible and copay/coinsurance for physical therapy?
A deductible is an amount you need to pay each year towards any health care services before the insurance starts to pay for your care. A copay is a dollar amount you must pay each visit, whereas co-insurance is a percentage of the cost of care you must pay each visit. Typically plans have a copay or coinsurance. We see many plans advertise a low monthly premium cost, but the fine print reveals that the copay for services is very high. These high costs can limit care and lead to poorer health outcomes, as examined by this recent study from the University of Washington.
While the healthcare landscape is difficult for both clients and providers to navigate, Sea Pines physical therapy wants you to get better, get moving, and start writing the next, rewarding chapter of your life. Getting these questions answered on the front end of care can help us work together towards achieving that goal.
