Deductible - The amount a patient pays for health care services before their health insurance begins to pay for visits/services. This is typically reset annually, at the time of insurance renewal. A patient is responsible for the entire cost of health services received until the patient has paid the deductible amount for health services.
Example: If your deductible is $1,000, you must pay $1,000 for any health service covered by your plan before your insurance will begin to cover a portion of health service costs.
Co-pay - The fixed amount a patient pays for a health care service, determined by the insurance company for a specific service, paid for at the time of service.
Example: If your co-pay is listed as $25, you will pay $25 for your health service, after your deductible has been covered. Your insurance plan will pay the remaining balance of the bill.
Co-insurance - The percentage of a medical charge that a patient pays after a deductible has been met, with the rest paid by your health insurance plan.
Example: If your co-insurance is listed as 10%, you will pay 10% of the payment that has already been made by your insurance carrier for the claim, after your deductible has been covered.
Total treatment days allowed per calendar year - Some plans designate a fixed amount of physical therapy sessions that they will cover for a calendar year.