Thank You for Choosing Our Practice for Your Physical Therapy Needs!

If at any time you have questions, please do not hesitate to ask. We know how frustrating and confusing understanding insurance coverage can be especially if you are unaware your insurance company employs a third party to administer your coverage (i.e. you have coverage with Cigna but start receiving notices from ASH or have coverage with United Healthcare and start receiving notices from Optum). We are here to help navigate this portion of your journey and make it as easy to understand as possible.

OVERVIEW: The Chiron Approach

Chiron Physical Therapy will contact your insurance company before your arrival to learn the exact parameters of your coverage … any financial responsibility, number of visits allowed, and if your insurance company requires additional paperwork to be submitted for you to be allowed to use your benefits.

Chiron will file claims on your behalf in a timely manner and monitor your benefits, submitting everything within the timeframes dictated by the terms of your insurance company.

Please know our focus is ALWAYS on you and working to get you better and back to the activities you enjoy. If at any time, finances are playing a role in determining the care you are seeking in our office, please let us know by calling or emailing Lindsay (lsimmons-campbell@chironptva.com) in confidence. We will work together to come up with solutions to ease the immediate financial burden and keep you focused on getting stronger and back to good health.

TERMINOLOGY: 

Insurance Coverage and Benefits:

Health insurance coverage is a contract between you and your health insurance plan and therefore they dictate your financial responsibility and benefits. Terms to be familiar with include:

Explanation of Benefits (EOB)
  • This is a statement that will arrive in your mail directly from your insurance company.
  • It provides details about your medical insurance claim that has been processed by your insurance company and explains what portion was paid to the healthcare provider and what portion of the payment – if any – is your patient responsibility.
    • Note: every time they provide services, your doctors, dentists, physical therapists and other medical professionals will submit claims to the patient’s insurance company to receive payment. In turn the insurance company sends out EOBs to the patient to inform them of the claims submitted, how much is being covered and how much the patient owes.
  • Any portion of the medical expense not covered by the insurance company will then be billed to you by your healthcare provider and payment should be paid directly to the appropriate provider.
  • This statement closely resembles a medical bill but it is not a bill.
  • Your healthcare provider also receives a copy of the EOB.
  • Upon receiving their copy, your healthcare provider will process the claim and will send you a bill – if appropriate – for the amount the insurance determined to be your financial responsibility that remains outstanding.
Co-Pay

A fixed amount determined by the health insurance carrier payable at each visit.

Deductible

The amount you – the individual – owes for health care services (medical, physical therapy, etc.) BEFORE the insurance company begins to pay.

For example: If an individual has a deductible of $1,000…

  • The insurance company will assign 100% of the financial responsibility for covered services to the patient up to $1,000.
  • Once the individual has paid $1,000 for covered services, the insurance company will then begin to pay.
Co-Insurance

The individual’s “share of the costs” of covered health care services as determined by the health insurance carrier . . . usually calculated as a percentage.

Individual pays the percentage (responsible for their share) AFTER they have completely satisfied their deductible.

For example: The individual has $1000 deductible and a 20% co-insurance…

  • The individual is 100% responsible for the first $1000 of their medical expenses for the year.
  • Every dollar expense thereafter is then split between the insurance company and the individual with the insurance company paying 80% and the individual paying 20%

So let’s say the insurance company allows $70 for the services rendered…

  • If you have not met your deductible, your financial responsibility would be $70 per visit
  • If you have met your deductible, the insurance company will pay $56 and deem your responsibility to be $14
In-Network Providers

Indication that your healthcare provider is contracted with the insurance company, generally resulting in less financial burden for the individual.

Chiron providers participate with Medicare, most major commercial insurance companies (including but not limited to Blue Cross, Anthem, Carefirst, Aetna, Cigna, United HealthCare, UMR) and some Medicaid plans.

Out-of-Pocket (OOP)

Out-Of-Pocket Maximum // Out-of-Pocket Limit // Maximum Out-of-Pocket

This refers to the maximum amount of money you have to pay for covered healthcare services in a plan year

  • Costs you pay for covered healthcare services count toward your out-of-pocket maximum including deductibles, co-insurance and co-payments.
    • Note:  Monthly plan premiums and services not covered by insurance do not count toward your out of pocket maximum.

Once you meet your limit / your maximum out-of-pocket maximum, your healthcare plan will pay 100% of all covered healthcare costs for the remainder of your plan year

Examples of how an out-of-pocket maximum might work:

  • Alice has a health plan with a $2,500 deductible, 20% co-insurance and a $4,000 out of pocket maximum plan.
  • At the start of the plan year, Alice sees her doctor regularly and receives medical bills totaling $2,500 … this meets her deductible which she pays and counts as monies applied to her out of pocket maximum.
  • As the year continues, Alice sees other doctors or specialists or physical therapy and is required to pay her 20% of those medical bills.
    • The 20% represents her co-insurance responsibility and these monies paid also count toward her out of pocket maximum.
  • Once Alice has paid $4,000 total expenses (in this case it would be the $2,500 associated with her deductible and the $1,500 associated with her coinsurance responsibilities) her health insurance carrier will pay 100% of her costs of covered medical care for the remainder of the plan year.
    • Therefore, from that point on Alice will pay ZERO dollars for medical care for the remainder of the plan year.

What We Need From You: Patient Responsibility

We ask you to provide and maintain accurate information.

If any information changes – i.e. address, phone number, physical address, email address, and/or insurance carrier – we ask you to inform us immediately. This will prevent insurance denials or billing errors that could possibly result in your insurance company assigning you full financial responsibility for the service rendered.

We require you to leave a credit card on file – our system is fully secured, and once data is entered no one can see the information nor make changes – to pay co-payments and/or have available to authorize payment toward your deductible and/or co-insurance responsibility upon receipt of your EOB.