(813) 643-1242

Insurance

Kotila Chiropractic is committed to making it easy to receive proper care by having an extensive list of covered insurance providers. We are constantly adding more insurance providers so please call (813) 643-1242 for the most up to date information.

MOST INSURANCE PLANS ACCEPTED.

 

Insurance Terms Glossary

Insurance can be confusing and difficult. However, we want to help you understand your insurance and the benefits that it affords you. By learning some of the general terms and what they mean, you can learn what sorts of benefits you have not only in our office but for any other doctor, specialist, or medical treatments you may need.

First, we will go over Insurance plans: HMO, PPO and POS

  • HMO: This is coverage through a health maintenance organization (HMO). With HMO coverage doctors can be chosen from a list of participating physicians. Primary Care physicians must refer patients for specialist needs. Specialists must also be chosen from a list of providers. Care from providers outside the program will not be approved for payment.
  • PPO: This is coverage through a preferred provider organization (PPO). Referrals are not needed for specialist visits, nor do the specialist need to be participating in the program to be partially covered. PPO programs may require a deductible to be met before coverage starts.
  • POS: This is a point of service plan (POS). This coverage offers the widest array of choices of any managed care program. By choosing providers within the program you save money, however the plan allows you to go outside the network for an additional cost of a deductible. This program provides the patient the most options in healthcare.

Hopefully that clears some things up about Insurance. Following are more common Insurance terms that you might have questions about:

  • Effective Date: This is the date when coverage started with the insurance company.
  • Deductible: A deductible is a dollar amount the patient needs to pay before the insurance company will start paying for a portion of the care. Most insurance companies will have an individual and/or family amount. You will need to find out what the deductible is and if any of it has been met and what is left. This will determine the amount the patient is responsible for.
  • Met: When you ask for the deductible amount you need to find out if any of the amount has been met to date.
  • Out of Pocket / Out of Pocket Met: In every policy there is an out of pocket amount. Most policies will have a $1000 – $2000 out of pocket. This number represents the actual amount the patient pays out of their own pocket. Make sure you ask how much has been met to this point.
  • Reimbursement % after Ded met / Co-Pay: This is pretty strait forward. You will put the 80/20, 70/30, what ever that particular policy has. Most insurance providers will have either a co-insurance or co-pay. The co-insurance is the 70/30 or partnership coverage with the insurance company. Co-pay is a set dollar amount that does not change based on the dollar amount of the individual visit. In most cases this percentage amount will be the same for all benefits with in this policy.
  • Pre-Existing: A pre-existing clause can be very important but rarely is it relative. Most policies will not have a pre-existing clause. When you ask if there is any pre-existing you should receive a yes or no answer. If the answer is yes, then you will need to make sure to call the insurance company on their first visit to find out what that clause is.