Health insurance can feel confusing and overwhelming. This quick guide explains the key terms, from premiums and deductibles to co-pays, co-insurance and in-network vs. out-of-network care, so you can feel confident before you start physical therapy.
Why health insurance feels so confusing
For many of our patients, navigating insurance is one of the most stressful steps in finding a doctor or physical therapist. What does in-network or out-of-network actually mean? What's the difference between a co-pay and co-insurance? And how does your deductible affect what you pay?
A quick note: the cost of services varies widely depending on your specific plan. To give you accurate information, we verify your insurance benefits before your first visit.
Key health insurance terms
| Term | What it means | Example |
|---|---|---|
| Premium | The monthly amount you or your employer pays to keep your health insurance coverage. | Paid monthly to keep your coverage in place. |
| Deductible | The amount you pay out of pocket before your insurance starts contributing to the cost of care. Deductibles reset each year. | With a $500 deductible, you pay the first $500 of medical services. After that, your co-pay or co-insurance applies. |
| Co-pay | A fixed fee you pay at each visit. | With a $20 co-pay, you pay $20 per visit, regardless of the total cost of the service. |
| Co-insurance | A percentage of the total service cost that you pay, set by your insurance plan. | With 20% co-insurance on a $100 visit, you pay $20. |
| Out-of-pocket maximum | The most you pay in a plan year, not counting premiums. Once your deductible, co-pays and co-insurance reach it, insurance covers 100% of authorized expenses for the rest of the year. | With a $2,000 out-of-pocket max, once you've paid $2,000 through deductibles and co-pays, insurance pays the rest of your covered medical costs that year. |
In-network vs. out-of-network providers
In-network providers
In-network providers have a contracted rate with your insurance company. Your standard deductible, co-pay or co-insurance applies.
Important: in-network providers are not always cheaper than out-of-network providers. Costs depend heavily on your specific plan and benefits.
Out-of-network providers
Out-of-network providers do not have a contract with your insurance company. You pay an agreed-upon rate, and your insurance may reimburse a percentage of that cost depending on your plan.
Important: out-of-network care is not automatically more expensive than in-network care. In some cases it may even save you money, depending on your deductible and benefit structure.
How Kauno helps you navigate insurance
At Kauno, we aim to make payment as transparent and stress-free as possible. Before your first appointment:
- We verify your insurance benefits for you.
- We explain exactly what you'll be responsible for financially.
- We answer any questions you have about your plan or coverage.
- We make sure you understand your costs throughout your care.
Our goal is to eliminate confusion so you can focus on what matters most: your recovery, performance and long-term health. If you're still deciding on a clinic, see our guide on how to choose the right physical therapist.
Not sure what your plan covers? We verify your benefits before your first visit.
book a sessionthe takeaway
Know your deductible, co-pay, co-insurance and out-of-pocket max, and don't assume in-network is always cheaper. Your specific plan decides what you pay.
Frequently asked questions
What is the difference between a co-pay and co-insurance?
A co-pay is a fixed fee you pay at each visit, such as $20. Co-insurance is a percentage of the total cost of the service, such as 20% of a $100 visit, which would be $20.
What is a deductible?
Your deductible is the amount you pay out of pocket before your insurance starts contributing to the cost of care. It resets each year. After you meet it, your co-pay or co-insurance applies.
What happens when I reach my out-of-pocket maximum?
Once your deductible, co-pays and co-insurance add up to your out-of-pocket maximum, your insurance covers 100% of authorized expenses for the rest of the plan year. Premiums don't count toward it.
Is in-network physical therapy always cheaper?
No. In-network providers are not always cheaper than out-of-network providers, and out-of-network care can sometimes save you money depending on your deductible and benefit structure.
Does Kauno check my insurance before my first visit?
Yes. We verify your insurance benefits before your first appointment and explain exactly what you'll be responsible for financially.
