Helping You Understand Your Insurance
Understanding Your Deductible
Most insurance plans have a deductible. These work in the same way as car insurance or home insurance in that you will owe the deductible amount first before your insurance will start to pay for your medical claims.
When admitting to an inpatient level of care, the deductible can met within 7 days.
Your treatment facility will not receive any payment from your insurance company until your deductible is met.
Co-Insurance
What happens after your deductible is met?
Typically, insurance companies will start to pay the treatment center for the services you are receiving – but they don’t pay the full amount. Instead they pay a percentage of the claim, with the expectation that you will also be financially responsible for the percentage of the claims they do not pay.
The Co-Insurance represents the percentage that is your financial responsibility.
For example, if the insurance company was going to pay $1,000 for the day, and you have a 30% co-insurance, you would owe $300 for that day.
Co-Pays
Co-pays refer to a fixed dollar amount that you owe for specific services.
Most insurance plans have a co-pay for medications and/or office visits. While these don’t typically apply for inpatient and intensive outpatient treatment, they may depending on your policy.
As you step-down to routine outpatient and weekly therapy, if you are using your insurance you may still be responsible for a co-pay associated with that visit.
Out-of-Pocket Maximum
Most insurance plans have an “OOP Max”. This functions just as it sounds, it’s meant to be the maximum that you would need to pay “out-of-pocket” during your plan year.
Once you reach your OOP Max, your insurance company pays at 100% of their allowable. This means there are no more co-insurance payments that you would be responsible for. While most policies have the deductible apply toward your OOP Max, not all do. It’s important to understand your specific insurance information.
Understanding Your Deductible
Most insurance plans have a deductible. These work in the same way as car insurance or home insurance in that you will owe the deductible amount first before your insurance will start to pay for your medical claims.
When admitting to an inpatient level of care, the deductible can met within 7 days.
Your treatment facility will not receive any payment from your insurance company until your deductible is met.
Co-Insurance
What happens after your deductible is met?
Typically, insurance companies will start to pay the treatment center for the services you are receiving – but they don’t pay the full amount. Instead they pay a percentage of the claim, with the expectation that you will also be financially responsible for the percentage of the claims they do not pay.
The Co-Insurance represents the percentage that is your financial responsibility.
For example, if the insurance company was going to pay $1,000 for the day, and you have a 30% co-insurance, you would owe $300 for that day.
Co-Pays
Co-pays refer to a fixed dollar amount that you owe for specific services.
Most insurance plans have a co-pay for medications and/or office visits. While these don’t typically apply for inpatient and intensive outpatient treatment, they may depending on your policy.
As you step-down to routine outpatient and weekly therapy, if you are using your insurance you may still be responsible for a co-pay associated with that visit.
Out-of-Pocket Maximum
Most insurance plans have an “OOP Max”. This functions just as it sounds, it’s meant to be the maximum that you would need to pay “out-of-pocket” during your plan year.
Once you reach your OOP Max, your insurance company pays at 100% of their allowable. This means there are no more co-insurance payments that you would be responsible for. While most policies have the deductible apply toward your OOP Max, not all do. It’s important to understand your specific insurance information.
What Can I Expect To Owe?
Every insurance plan is different. For specifics about your plan you should consult your insurance benefit package or reach out to your insurance company.
While some plans have distinct deductible & out-of-pocket maximums, most policies we’ve seen have the deductible apply toward the out-of-pocket maximum.
When considering a thirty to ninety day treatment episode, most patients will incur daily costs which greatly exceed their out-of-pocket maximum. As a result, most estimates will be driven off your specific insurance plan’s OOP Max.
*It’s worth noting that our estimates are just that – an estimate. They are subject to changes based on a variety of factors including: your insurance resetting, outstanding insurance claims (but unprocessed), human & insurance errors, and other factors.
Frequently Asked Questions
We’re here to help. Check out our FAQ for more information about how to understand your insurance policy.
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