A Quick Guide To Health Insurance
Understanding what your health insurance plan covers can feel confusing and overwhelming. 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 impact what you pay?
This quick guide breaks down key health insurance terms so you can feel more confident before starting care.
A quick note: When using health insurance, the cost of services varies widely depending on your specific plan. To give you accurate information, we must verify your insurance benefits prior to your first visit.
Key Health Insurance Terminology
Premium
The monthly amount you or your employer pays to maintain your health insurance coverage.
Deductible
The amount you must pay out of pocket before your insurance begins contributing to the cost of care. Deductibles reset each year.
Example:
If your deductible is $500, you are responsible for the first $500 of medical services. After you reach that amount, your standard co-pay or co-insurance applies.
Co-pay
A fixed fee you pay at each visit.
Example:
If you have a $20 co-pay, you pay $20 for every visit, regardless of the total cost of the service.
Co-insurance
A percentage of the total service cost that you are responsible for paying. This amount is determined by your insurance plan.
Example:
If your co-insurance is 20% and your visit costs $100, you pay $20.
Out-of-Pocket Maximum
The maximum amount you are responsible for paying within your plan year (excluding premiums). Once you've reached this amount through your deductible, co-pays, and co-insurance, your insurance will cover 100% of authorized expenses for the rest of the year.
Example:
If your out-of-pocket max is $2,000, and you reach that amount through deductibles and co-pays, insurance will pay the remainder of covered medical costs for that year.
In-Network vs. Out-of-Network
In-Network Providers
These providers have a contracted rate with your insurance company. Your standard deductible, co-pay, or co-insurance applies.
Important note:
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
These providers do not have a contract with your insurance company. You will pay an agreed-upon rate, and your insurance may reimburse a percentage of that cost depending on your plan.
Important note:
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 ensure 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.
