Insurance Benefits can be confusing and, although most benefit information is available through your employer or on-line, we here at Northwest Wellness and Chiropractic in Federal Way want to help you through the tangled web of copays, deductibles, allowed amounts and coverage limits. We understand that it is difficult to determine exactly what may of may not be covered by your plan and will assist you in obtaining the care that you need.
What is a Yearly Deductible?
The yearly deductible is the amount you owe for covered health care services before your plan begins to pay. The deductible may not apply to all services and can range anywhere from $500-$3000.
What is a Copayment?
A copayment is a fixed amount that you pay for a covered health care service, due at the time of service. The amount can vary bu the type of covered services provided and typically ranges from $20-$30. Copays can be significantly higher for specialists or emergency room visits.
What is Coinsurance?
Your share of the costs of a covered health care service calculated as a percent of the allowed amount for the service. Frequently coinsurances range for 10-20%. You are responsible for paying copayment, coinsurance plus any deductibles.
What is the Allowed Amount?
The allowed amount is the difference between the amount billed by your doctor and the contracted fee your provider accepts to participate in the plan. If you see a network provider within your plan the difference is written off by your provider and that becomes the allowed amount that your deductible and coinsurance is based upon. This is for covered services only.
What is the Provider Discount?
Most providers are contracted by specific insurance companies to provide treatment to their insured. When doing so, the providers agree to take a discount on the services provided. Typically the paid amount is 30-50% less than the billed amount. Those discounts are then passed onto you, the consumer.
What Services Are Covered by My Plan?
All plans underwritten in Washington State are required to have “Any Category of Provider” which requires them to provide coverage for a licensed practitioner of any specialty that is able to treat your condition; including Doctors of Chiropractic, Licensed Massage Practitioners and Licensed Acupuncturists. Rehabilitative Exercise is covered by most plans under the Doctor of Chiropractic. Medical Weight loss is typically not covered by insurance.
How Does the Billing Process Work at Northwest Wellness in Federal Way?
Our insurance specialist bills electronically every week. It typically takes a minimum of 30 days for an insurance company to pay your bill. If you have a copay, it is collected each visit and applied to your account. If you have a coinsurance then we bill you the specified amount directed by your insurance company after they pay their portion. Keep in mind that the amount billed is rarely the amount paid as most insurance companies take the Provider Discount from the doctor’s billed amount