Insurance Basics

Do I Need a Referral?

Colorado is a “direct access” state, so the short answer is probably not. All self-pay patients and most patients with commercial insurance plans do not require a referral to see a physical therapist. If you are unsure whether you need a referral, give our office a call and our team can let you know if your particular situation requires a referral. (You can also check with your insurance directly.)

What is a copay?

A copay is a flat rate that you will need to pay at each visit. The amount is determined by your insurance plan. 

What is a deductible and coinsurance?

The amount you will pay towards your deductible or coinsurance at each visit will depend on your insurance company and plan. Many insurance companies have a flat, contracted rate so you don't have to pay the full amount of each visit. To get a cost estimate, you should call your insurance to learn about your benefits and then call our office. Our administrative staff can help explain your payment responsibility. 

Plans with a deductible require you to pay for your care until the deductible is met. The insurance company does not cover any cost until the deductible is met. Once it is met, most plans have a coinsurance, which means you will pay a percentage of the cost and the insurance company pays the rest. The deductible and coinsurance amounts are determined by your insurance plan, and the deductible will renew when your plan year renews. 

What is an out-of-pocket maximum or stop loss?

Your out-of-pocket maximum, also known as a stop loss, is the maximum amount you will pay for medical care during your plan year. Once you reach your out-of-pocket maximum, your insurance company will cover your care at 100%. Your out-of-pocket maximum renews when your plan renews, and the amount is determined by your insurance plan.