Insurance Deductible Explained

Understanding Your Health Insurance deductibles can save you money in 2021, so today we are going to answer two very important questions. How do I  meet my deductible and why do I have have to pay my deductible?  Now is a good time to discuss this topic as you may have met your deductible. Understanding what this means can assist you in planning for major healthcare expenses and save you a few dollars in 2021. 

Why Do I have to Pay my Deductible?

When you choose a healthcare plan, you are entering into an agreement with the insurance company. You agree to pay a certain amount of your healthcare services before your insurance company is obligated to share in the cost of those services. When your healthcare provider bills your insurance company for services rendered, they are legally bound to charge you for those services if your deductible is not met. 

When choosing a healthcare plan, make sure the deductible amount is an amount you can afford. If you have a lot of healthcare expenses, it may be better to choose a plan with a lower deductible. This can result in a higher monthly premium, but reduce your overall cost for the year. Having a large deductible that you are unable to pay can result being sent to collections for unmet payments to your healthcare provider. Be informed and make the best decision that works for you. 

How Do I meet my Deductible?

A frequent question at our clinic is: I have already met deductible. Why am I having to pay my deductible for physical therapy? When you pay for a service that payment goes towards your deductible, but there are a couple of factors that can make you think you have met your deductible when you have not. 

    1. Your insurance company has rules to determine how much of your payment for a service goes towards your deductible.  Every dollar you pay may not count toward your deductible. 
    2. Once you receive a service from a provider, the provider can take up to a year to submit a claim.  When the provider does not immediately submit their claim the insurance company has no way of knowing that you have made a payment toward your deductible. In the eyes of the Insurance Company your deductible is not met and you will have to pay toward it until it is. 

 Multiple providers can send in claims at the same time, so money is applied toward your deductible in the order that the claims are received.  If you pay your deductible in advance to a provider ,that is slow to submit their claims, you will be owed a refund for your payment.

The key is to educate yourself on your Health Insurance benefits and track your cost. Every time you use your health insurance, your insurance company will send you an explanation of benefits (EOB) explaining how much you owe the provider. Look at the EOB to track your expenses and ask for a refund if you have over paid. 

Know your insurance benefits

Ultimately, you are the one responsible for understanding your insurance benefits. It is best for you to call your insurance company and know what your costs are before you receive healthcare services. Doing this will allow you to budget for your healthcare cost and NOT receive unexpected bills. 

How to save on Healthcare in 2021

On January 1, 2022 you will have to start paying toward your deductible again. This will  increase your cost for receiving healthcare services. You can reduce your healthcare expenses by receiving services in 2021. Some insurance plans reset the deductible on October 1, 2021. You can find your benefit period on your insurance card. 

You can be seen At Lifestyle Physical Therapy without a prescription. Our Doctors of physical therapy can perform a free screen to determine if physical therapy is the best approach for you.  Now is the best time to get back to doing the things you love without pain or fear of falling. 

Call or text our offices today at 803-831-1454. Katie and Lauren are standing by to verify your insurance and schedule your appointment. 

This Article is intended for education Purposes only. Insurance plans are individual. Your plan may not fit in the scenario above. Consult your insurance company to fully understand your deductible and health insurance plan.