Insurance terms can be very confusing to the average person, however the one we get the most questions about is the DEDUCTIBLE.  What is it and what does it mean for the cost to go “towards my deductible”?  Hopefully I can clear this up for you below!

First, let’s define it.  A deductible is the amount of money a patient pays out of pocket for covered healthcare services before their insurance plan starts paying.  If you have a $1500 deductible then you will be expected to pay towards that $1500 total until it has been met.  After it has been met, patients will pay a copay or coinsurance (a percentage of the cost).  You should understand that the deductible is expected up front and it is part of your contract with your insurance company to pay.  The cost for the deductible amount will depend on your provider’s contracted rates with your insurance company and can vary depending on what kind of services you are getting.  These payments will go directly to your provider, not your insurance company.  

Typically your deductible will reset at the beginning of the year (if your plan runs January-December) so be aware that your out of pockets medical costs will be higher when that occurs.  

When choosing your health plan, you may wonder if it’s better to have a high deductible plan with a low premium (what you pay/contribute to have health insurance) or a low deductible plan with a higher premium.  High deductible plans work well for people who have or anticipate very few medical expenses.  Low deductible plans work well for people who have chronic conditions or anticipate many doctor visits during the year.  It is important to note that deductibles usually don’t apply to wellness visits or other types of standard doctor visits.  

Here are some ways to help with the cost of deductibles:

1. Inform your providers of ANY changes with your insurance plans, even if just the number changes.

2. Confirm if your health plan requires you to use certain providers (in-network) only.  Your deductible may be higher if you use an out of network provider.

3. Ask your healthcare provider if they will set up a payment plan to help spread out the cost of services.

4. Call the member service number on the back of your insurance card to ask about any services you may be scheduling.  Ask if there will be a copay or a deductible.

The billing team at Wilson Pediatric Therapy is alway willing to help you understand your insurance deductibles and the breakdown of costs.  Please either call/text 859-475-4305 or email billing@wilsonpediatric.com with any billing questions.