As we enter a new year, reviewing your insurance benefits is a good idea, especially if you’re considering outpatient rehabilitation services like physical, occupational, and speech therapy.
Many insurance plans reset at the start of the year, impacting coverage, deductibles, and out-of-pocket costs. To help you navigate these changes, here’s what you need to know about using your insurance for rehab services in the new year.
1. Verify Your Coverage
Insurance plans often change their coverage at the start of each year. It’s important to check with your provider to see if outpatient rehab services are covered and how many visits are allowed per year.
While clinics try to help track the number of visits used, families should keep track themselves. Clinics may not know if visits have been used at other locations, which could affect the total allowed.
Most insurance plans only cover one evaluation per specialty each year. Be sure to check for any changes in co-pays, deductibles, or co-insurance rates, and find out if a referral or pre-authorization is needed.
2. Understand Your Deductible
Most insurance plans have an annual deductible that resets in January. A deductible is the amount you must pay out-of-pocket before your insurance starts covering services. If you’ve met your deductible in the previous year, be prepared for potential upfront costs at the start of the new year.
3. Check Your Co-Pay or Co-Insurance Responsibilities
Even after meeting your deductible, you may still be responsible for a portion of your therapy costs. This could be a set co-pay per visit or a percentage of the service cost (co-insurance). Knowing these amounts in advance can help you budget accordingly.
4. Confirm In-Network vs. Out-of-Network Providers
Using an in-network provider usually results in lower out-of-pocket costs. If you are switching providers or your current provider has changed their insurance agreements, check to ensure they are still in-network with your plan.
5. Pre-Authorizations and Referrals
Some insurance plans require pre-authorization for outpatient rehab services. This means your doctor must submit documentation proving medical necessity before therapy sessions can begin. Failure to obtain pre-authorization could lead to denied claims and unexpected bills.
6. Utilize Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA)
If you have an HSA or FSA, you can use these pre-tax dollars to cover therapy costs, including deductibles, co-pays, and other out-of-pocket expenses. Be sure to check your account balance and plan your therapy visits accordingly.
7. Appeal Denied Claims If Necessary
If your insurance denies coverage for therapy services, you have the right to appeal. Work with your provider to gather medical documentation and submit an appeal to your insurance company.
8. Ask About Payment Plans or Financial Assistance
If therapy costs are a concern, ask your provider about payment plans or financial assistance programs. Many outpatient rehab centers offer flexible payment options to help families manage expenses. At Crawl Walk Jump Run Therapy Clinic we offer Care Credit to assist as a payment option for ongoing therapy services.
9. Stay Informed and Be Proactive
The best way to avoid unexpected costs is to stay informed and proactive. Contact your insurance provider, ask questions, and keep track of your coverage details throughout the year.
Understanding your insurance benefits at the start of the year can help you plan and make informed decisions about outpatient rehab services. By verifying your coverage, checking costs, and staying proactive, you can ensure that you or your loved one continues receiving the necessary therapy without financial surprises. If you need assistance understanding your benefits, don’t hesitate to reach out to your provider or therapy clinic for guidance.
Need help verifying your insurance benefits? Contact us today, and we’ll guide you through the process!
