Health Care Deductibles in the New Year–What you need to ask, and know

It’s the beginning of a new year, and while the calendar change can mean a fresh start, it also means you could be in for a bit of a headache if your deductible has reset.

Your deductible is the amount you are responsible for paying before your insurance will begin paying for services. Deductibles vary widely based on the insurer of your health plan. For example, if your deductible is $2,000, you must pay the first $2,000 of your health care expenses on your own. Your insurance will begin covering your expenses after you meet the deductible.

If your deductible resets in January, you are essentially back at square one, when it comes to your contributions. If you rarely see a health care provider, you may not even notice, or be affected by the reset. But, if you have underlying health conditions, or require specialists, each January you’ll be facing a new deductible. You’ll need to meet this deductible before your insurance will begin paying for your care.

It’s important you know about your benefits and responsibilities so you don’t suffer the “sticker shock” of having to pay out of pocket after your massage. We are happy to call and get this information for you as well, but as providers we often get limited information. Also, it is important that you understand your own policy limitations and coverage.

Here are some questions to ask your insurance company:

  • Do I have a deductible? If so, does my deductible apply to chiropractic, physical therapy and/or massage therapy?
  • Do I have a co-payment or co-insurance for these services?
  • Am I limited to a certain number of treatments per year or a dollar limit for these services?
  • Are these benefit limits shared between chiropractic, physical therapy and massage therapy or does each type of treatment have its own?
  • Is physical therapy covered if it is performed by my chiropractor?
  • Is massage therapy covered if it is performed by a licensed massage therapist?
  • Do I need a referral or prescription for any of these services? If so, where should the referral come from? For example, can the referral or prescription for massage therapy come from my chiropractor?
  • Have I used any of these services to date?
  • Is my plan a calendar year plan or other?

Finding out about your benefits and any potential deductible requirements can prevent unexpected bills. Check with your insurance provider for any updates or changes to your benefits.

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