Patient Education

understanding-insurance-largeAt Florida Sports and Spinal Rehab we understand how difficult it can be to understand your insurance benefits and we’re here to help! Below are several resources that we’ve compiled to better assist you in understanding your insurance. Please remember that for questions regarding your specific insurance plan the best resource is your insurance company. Please refer to your insurance provider for additional information on your unique benefits.


Understanding your coverage

When you buy an insurance plan, you join a group of other people to combine your healthcare purchasing power. That way, everyone shares the cost of staying healthy. You also agree to pay a monthly fee in exchange for a variety of benefits. Below are several of the most common terms you’ll come across. Becoming familiar with them will make it easier to understand the details and total cost of the plan.

What is a Deductible?

Your deductible is the amount you’re responsible to pay for covered medical expenses (the medical services that are covered under your plan) before your insurance begins to pay each year. When you hear that someone has “met their deductible,” it means they have paid their part of their healthcare costs. Their plan will begin to pay its portion for healthcare costs; however, you may still have to pay a co-pay or a percentage of the cost of care, called coinsurance. Typically, anything you pay out of your own pocket, except for premiums, co-pays and some prescription drug costs, will go toward meeting your deductible.


What’s a Co-Payment?

Some plans include co-pays. These are set prices for various services you may need. For example, you may pay a $20 co-pay for a visit to your primary care physician, or a $100 co-pay for a visit to the emergency room. Paying your copay each visit does not mean that all service rendered will be at no further cost to you. Depending on whether or not you’ve met your deductible further payment for services may be required once your claims are processed.


What is Coinsurance?

Coinsurance means the costs of covered medical services are shared between you and your insurance company after the deductible has been met. For example, if a plan has 80/20 coinsurance, the plan would pay 80 percent of a covered medical expense, while you would pay 20 percent of the same covered medical expense.


Maximum Out-of-Pocket

This is the most money you will be required to pay in a year for deductibles, coinsurance and co-payments. It is a specific dollar amount that is part of the health insurance plan. After you’ve reached that amount, the insurance company may cover the cost of the rest of your covered medical expenses.


Claims

After you have a medical service, the doctor or facility that provided that service will file a claim with your insurance company. A claim is a formal request asking for payment based on the terms of the insurance plan. Your insurance company will review the claim to make sure it is valid. If so, the appropriate amount will be paid out to the insured person or to the doctor or facility that filed the claim. Depending on your plan not all services rendered may be covered or you may be responsible for a percentage of the cost.


Insurance Disclaimer:

Florida Sports & Spinal Rehab’s facilities and physicians accept most insurance plans. The list of insurance companies and their plans that are accepted are listed here for your convenience. Plans change frequently so if you have questions about whether or not we participate in your specific insurance plan, please verify with your insurance company directly.

It is the responsibility of the patient to verify that his/her insurance plan will cover medical services provided by Florida Sports & Spinal Rehab. Please verify with your insurance company prior to having services at Florida Sports & Spinal Rehab.