How to use your out of network benefits! Easy claim submission!
Move Free Physical Therapy has partnered with Reimbursify to make it easy for you to submit your claims for out-of-network health insurance reimbursement using your smartphone. Download the app and get your first claim free (future claims are less than $3 each):
How does my Insurance Work?
First off, let's define a few terms.
Premium: This is the amount you pay each month in order to say "I have insurance"
Deductible: This is the amount of money you must pay in a year before the cost sharing of insurance kicks in. Usually there is an "in-network" and "out-of-network" deductible
Co-Insurance: Once you've met the deductible, this is the amount of your bill you're responsible to pay. In an 70/30 plan, once you've met the deductible, the insurance will pay 70% of the allowed amount, and you will be responsible for the 30%
Balance Billing: What you get billed an amount after the insurance gets pays its part
Prompt Pay Discount: What you pay at time of service
OK I see, how do I get this information?
In an out of network situation, (where you want to see a provider who isn't in network with your insurance company), you should call the number on the back your insurance card and ask:
What are my out of network benefits for ____? (Physical Therapy, Mental Health services, Specialist visits, etc)
Write down your: Out of Network (OON) Deductible; Amount of OON Deductible Met; Co-insurance percentage
With this information you can now make an informed choice with your chosen provider regarding Prompt Pay Discounts, or Balance Billing of the full charge rate
How does a Prompt Pay Discount work?
You pay a discounted rate at time of service
You take a "superbill" and submit it to your insurance
You receive reimbursement of the insurance's portion of the discounted rate (say 70% in our example above), once you have met your deductible
What about Balance Billing?
You ask the provider to bill OON to your insurance provider (who will be billed at the full charge rate)
Your insurance provider will pay the provider their portion of an "Allowed Amount" (an amount less than the charge rate) after you have met your deductible
You will then be responsible for the difference between the charge rate and allowed amount + your co-insurance (the 30% in the example above); or the full charge rate if you have not yet met your deductible
In most scenarios, especially with high deductible plans, you will come out ahead with paying at time of service and submitting your own claim to insurance for reimbursement. You will know what to expect, and you will not have any surprise bills months down the line.
Also, please remember, your provider is NOT obligated to bill your insurance for you and may do so as a courtesy. But you can feel free to ask about a "Prompt Pay Discount" and for the "superbill" so you can submit toward your own insurance.