I owe what? I'm so confused....

What do I owe?  It’s so confusing, I don’t understand.

If you get a bit tripped up understanding the insurance lingo and struggle to understand what your financial responsibility is and why, you are not alone!  Usually the portion of the payment for which the patient is responsible is either the deductible, coinsurance or copay.

A deductible is an amount set in the insurance contract that is paid in full prior to the insurance company paying some or all of the payment to your healthcare provider.  The amount of deductible varies widely between policies.  On the low side a deductible may be $150.  High deductible policies could have upwards of $6000 per policy year. 

A typical policy with a deductible will also require coinsurance once the deductible has been met.  The coinsurance amount is a percentage of the allowable payment for the visit procedure.   To simplify the example, let’s say that the reimbursement to your physical therapist for your treatment is $80 each visit.  (This is purely an example, as most visits are based on the reimbursement of therapy procedures during each visit and the amount may vary depending on treatment.  Some insurance companies may have a flat reimbursement rate contract with a provider.)  Following the example, if you have a $1500 deductible, you will owe the full amount of the therapy visit, in this case $80, until the deductible has been met by any of your medical visits which apply to your deductible.   So, any doctor’s visits, specialist visits, diagnostic testing, urgent care visits, etc. will all go toward your deductible per your insurance policy.    If you owe a coinsurance after reaching your deductible, then you would owe that percentage of the visit versus the whole reimbursement amount.  So, to follow our example, if you have a 20% coinsurance, once your $1500 deductible has been met, you owe 20% of the reimbursement for your therapy visit.   In our example that would be 20% of $80 or $16 per visit. 

The last form of patient responsibility, the copay, tends to be more straight forward than coinsurance.   Copays are a flat fee owed at each visit.  The copay owed may vary as to whether you are seeing your primary care physician or a specialist.  Copays usually are not tied into a deductible.  

It’s always advisable to verify your benefits with your insurance company so you don’t end up with any surprise expenses.    Don’t hesitate to ask for clarification from your insurance company with your questions and concerns.  


Kristen Pagano, Administrator

How P.T. can help pain and fight the opioid epidemic

The United States has a big problem. We have become a place where opioid medication is handed out almost like candy to deal with pain of all types. We consume 99% of the world’s supply of hydrocodone. So, we should all be feeling great, right? Sadly, no. While the number of people using pain medication has increased, reported pain has not changed. Also, there are serious side effects that may occur with using these types of medications.  One of the most serious side effects is that these medications are habit forming. In 2014, two million Americans were addicted to opioid pain medications. This can often lead to abuse of other illegal drugs.


In 2016, The United States Surgeon General sent a letter to doctors addressing the issue. As part of the plan to fight this epidemic, several suggestions were put forth. One of those things was the use of exercise and physical therapy as a type of treatment that should be considered before prescribing addictive pain medication.

So how can physical therapy help?  Physical Therapists are uniquely trained to assess and manage musculoskeletal pain and dysfunction. Physical therapists can help guide patients through exercise programs tailored specifically for their problem as well as provide hands on manual therapy techniques designed to improve mobility and reduce pain. Physical therapists can also provide education on ways to lessen your pain and strategies to get back to normal life. In a study published in the journal Health Services Research, findings indicate that patients who saw a physical therapist before trying other treatments had an 89% lower probability of needing an opioid prescription. 

Physical therapy is a frequently under-utilized option that should be considered as a first line treatment for pain. It offers an opioid free, long term solution for treating the primary cause of pain. If you, or someone you know, is suffering with pain due to a musculoskeletal issue, consider asking your doctor about physical therapy or call us directly at 717-790-9994 to set up an appointment to be evaluated.


Stephany Primrose, P.T.

Exercise: A Natural Remedy for Depression

As many people know, exercise helps prevent or improve a multitude of health problems, including high blood pressure, diabetes and arthritis. However, research on depression and anxiety shows that the psychological and physical effects of exercise can also help improve mood and reduce anxiety.

How does it work? Scientists aren't entirely clear on the link between exercise and its effect on mood but they do know it has many benefits to the body and mind. Regular exercise may help ease depression by stimulating the release of endorphins, natural “feel-good” brain chemicals that improve your sense of well-being. Activity also helps take your mind off of your worries which helps reduce the cycle of negative thoughts that can feed depression. For many people they find that exercise improves their self confidence, gives them a healthy coping mechanism for stress and it encourages social interaction.

You may wonder how much and what type of exercise you should try, especially since depression may make exercise the last thing you want to do. The good news is, you can exercise in a number of ways. Walking, running, playing sports or taking exercise classes can all get your heart and body moving. But you can also increase your activity with smaller changes such as taking the stairs instead of the elevator, doing yard work or parking farther away from work or school.

Completing 30 minutes or more of exercise a day for 3-5 days a week may significantly improve depression symptoms, but even smaller amounts may make a difference.

You should  check with a health professional before beginning a new exercise program to ensure that it is safe for you. Exercise can be a helpful part of managing your depression, however please continue to follow the advice and treatment provided by a mental health professional.

 Stephany Primrose, P.T.


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Disclaimer:  The information in this medical library is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website.

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