Types of Insurance Plan.  In order to help you understand how different insurance plans work we have summarized the various types:

Health Maintenance Organization (HMO)

Health Maintenance Organization allows you to select the primary care physician from a list of doctors  in the network. HMO's require a referral from your primary physician to your insurance carrier.

Preferred Provider Organization (PPO)

Preferred Provider Organization allows you to see doctors and hospitals within the PPO network or outside the network. Although this plan offers more flexibility, out-of-pocket costs tend to be higher.

Medical Savings Account (MSA)

Medical Savings Account is a tax-advantaged personal savings account used in conjunction with a high-deductible health policy. Individuals can contribute money to this account on a pre-tax basis to set aside money for qualified medical care and expenses, including annual deductibles and co-payments.

Point-of-Service Plan (POS)

Point-of-Service Plan is a type of managed-care combining the features of HMOs and PPOs. You can decide whether to go to a network provider and pay a flat rate or to an out-of-network provider and pay a deductible and/or a coinsurance charge.

Indemnity Plan

A fee-for-service or traditional plan that gives you freedom to visit any medical provider without referrals or authorizations. This plan includes a deductible and a charge for covered services, with the insurance company paying 80 percent; the patient paying 20 percent.

Insurance Benefits

It is important to call your insurance carrier for your exact benefits. The number to call is located on your insurance card under customer service. When you make the call ask specifically for your outpatient   physical therapy benefits.

The four questions to ask are as follows:

         1.  What is my deductible?

         2.  What is my co-pay?

         3.  What is my co-insurance?

         4.  What are my in- and out-of-network benefits?

Glossary of Terms

         1.  DEDUCTIBLE is the amount you have to pay before insurance will begin paying your claim.  For example: Your deductible is $250.00. After you pay up to that amount out-of-pocket your insurance will   then begin to pay you claims.

         2.  CO-PAY is the amount you pay every time that you go to see your doctor or physical therapist — this is separate from co-insurance. For example: Each visit to your doctor or physical therapist you pay   $10.

         3. CO-INSURANCE is the percentage that you are responsible for after the insurance carrier has made its payment. For example: Insurance covers 80 percent of the charged amount and you are responsible for the 20 percent.

         4. Out of Network Benefits- Most insurance plans (other than HMO’s) have out-of-network benefits. These benefits normally have a deductible and higher co-insurance payments, e.g., $250 deductible and 70/30 coverage after the deductible is met.

To get your out-of-network benefits call the number on the back of you insurance card.