This is the amount we bill your insurance for each service.

This is the sum of what will be paid for each service by the insurance company and/or by the patient.  Your insurance determines the allowed amount.

This is the difference between the billed amount and the allowed amount.  You are not responsible for this amount unless you have agreed to pay for a specific service that your insurance does not cover.

This is the amount you owe to the provider who performed the service.

This is an amount that you owe to the provider before your insurance pays on services you receive.

This is the most you will have to pay as patient responsibility in a given year.  Once you have met your Out of Pocket Maximum, insurance will pay the provider the full allowed amount.

A set fee that your insurance company determines according to your plan for a given service paid to the provider.  Usually between $10 and $60, this amount may be applied to your deductible or separate from your deductible, as well as your out of pocket maximum.  This amount is paid at the time of service.

A percentage of the allowed amount your insurance company determines according to your plan.  Typically between 10%-40%, this amount is usually applied to your deductible and out of pocket maximum.  This amount is reported to the provider when your insurance company has determined the validity and outcome (called adjudication) of the claim.  This amount is paid to the provider.

Includes what the insurance paid the provider and the patient responsibility due to the provider.

 The number of visits allowed in a given period for a specific benefit or a group of benefits.  Benefits which may be included in a visit limit are therapies such as occupational therapy, physical therapy, acupuncture, and massage.  It is the patient’s responsibility to keep track of their usage of visits.  Once the visit limit has been reached the patient is responsible to pay for services at the time of service rate.

 Your insurance may require a referral from your physician.  Please check with your insurance to see if a referral is required prior to scheduling an appointment.  If a referral is required and services are performed without a referral, the treatments will be paid out of pocket at time of service rates.

Your insurance may require authorization.  Please check with your insurance to see if authorization is required prior to scheduling an appointment.  We will help to obtain the authorization, if needed.  Typically, authorizations are for a limited time and or number of treatments.  If authorization is required and services are performed outside of the authorization, the treatments will be paid out of pocket at time of service rates.