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Insurance Patients

At Body Gears, we want our patients to be fully aware of their options regarding their health care. This means understanding the in’s and out’s of health insurance.

In order to determine how much you will owe for a date of service, it is imperative that you know your benefits.  Insurance plans can have deductibles, co-insurances, co-pays, or any combination of the three.  Understanding what your insurance company will cover and what your out-of-pocket expense will be before your plan of care begins will help you plan and budget accordingly, so you are not surprised by any balance you may be asked to pay.

A deductible is an amount of money set by your insurance policy that needs to be paid out-of-pocket annually before your insurance company will start to pay out benefits.  Once you meet this deductible amount, you still may owe for co-insurance or co-pay amounts.

A co-pay is a fixed dollar amount to be paid by you before your insurance company will pay out any benefits for a specific date of service.

Co-insurance is a percentage of the total payable amount that you will owe for a specific date of service.  These are usually presented as 80%-20% or 70%-30%.  The first percentage indicates the portion of the payable amount your insurance company will cover, while the second percentage indicates the portion of the payable amount for which you will be responsible.  Example: If you have an 80%-20% plan and if the payable amount for your date of service is $100, your insurance company will pay $80 towards the total, and you will be responsible for the remaining $20.

Body Gears accepts both in-network and out-of-network insurance plans.

In-network – Your provider’s office is contracted with an insurance company to accept their discount for a date of service (payable amount).  Benefits are calculated based on this payable amount.

Out-of-network – Your provider’s office is not contracted with an insurance company.  Many plans offer out-of-network benefits, so they are calculated based on the total billed amount. 

For an example of how these benefits can work for you, please see Benefits Example #3 below.

For an in-network plan with deductible met and a patient responsibility of 30% co-insurance.

Billed amount = $400

Payable amount after in-network discount = $120

Insurance company pays $84 and patient pays $36

For an in-network plan with $1,500 remaining for deductible

Billed amount = $250

Payable amount after in-network discount = $98

Patient pays $98, which reduces the deductible to $1,402

For an out-of-network plan with deductible met and a patient responsibility of 40% co-insurance.

Billed amount = $250

Insurance company pays $150 and patient pays $100

**For the price of a 30-minute self-pay visit, you receive a 60-75 minute visit**

Learn more about our Self Pay Program!