We make fitness fun and keep it interesting at Pinnacle. Our enthusiastic and friendly team is here to motivate, teach, and put you on a personal path to your best. You’ll find everything you need to keep yourself motivated, engaged, and challenged to reach your personal best, no matter how old or good you are.
Pinnacle Health and Fitness have state-of-the-art equipment, a heated saltwater pool, group classes, and one-on-one personal training. It is also home to Hillsborough Family Martial Arts, Splash Swim Academy, Grin Summer Camp, and Premiere Dance.
Why should you join the Pinnacle family?
We promise you’ll never feel like a number. Our teachers and staff work hard to understand your needs and ensure your fitness plan fits your goal. We are always coming up with new ways to assist you in remaining motivated and connecting you with the other Pinnacle members. These connections are what keep you on track as well as coming back.
Understanding your top health benefits
You trip and hurt your back. Your doc told you that you require physical therapy. You go to physical therapy 10 times without checking with your insurance, and you feel great. Your doctor told you you needed it, so you must be fully covered, right? Then, two weeks after that, you get a bill in the mail for $600.
What could be going on? You think, “I pay my insurance premium monthly, so I shouldn’t get a bill.” This shock can be avoided if you know and understand how your benefits work, which can also assist you in organizing your finances.
Prepare ahead
First, CALL your insurance company before you get any medical care. On the back of their insurance card, you can always find a phone number for Members Services. Use this phone number often! This will help you determine if your insurance covers any procedure, test, or visit you might need.
Many think their insurance will cover anything their doctor tells them to do. It’s not like that. Almost nothing is ever completely covered. This is why calling your insurance company before getting services is so important. We have a worksheet to help you figure out how to check your insurance benefits.
Recognize your advantages
Next, you need to know your benefits and how they work. Knowing your benefits is great, but if you don’t understand them, you’ll be just as shocked as if you didn’t know them. You may need to pay a deductible and coinsurance or just a copay for the services you get.
A health insurance deductible is similar to the tax deduction on your car or home insurance. This is the quantity you must pay out of your pocket once a year before your insurance will pay anything. This amount can be anywhere between $50 and more than $10,000. As you might guess, knowing this number is very important.
Deductibles
Before you’ve met your deductible for the year, you’ll have to pay for covered healthcare services yourself. Only after you’ve met your deductible will your insurance plan start to pay. Depending on the insurance plan, most deductibles can range from $250 to $5,000. After you’ve paid your deductible, your insurance will start to pay for a portion of the bill.
This can be anywhere from 50% to 100% of the insurance rate that was agreed upon. This means that AFTER you’ve paid your deductible, you may still have to pay up to 50% of your bills. When a service is a copay, you must pay a set amount every moment you get it. Copays can be as low as $5 and as high as $60.
Copayment and coinsurance
So, what’s the difference between a copay and a coinsurance? I thought you would never ask such a good question. Coinsurance is a portion of the total bill that your insurance provider requires you to pay. A copay is like a service fee that you pay at your appointment. Coinsurance can be anywhere between 5 and 50 percent.
Once you’ve paid your deductible, your insurance will pay a portion of the bill, and you’ll have to pay the rest. So, let’s say you have met your deductible and have a 20% coinsurance. $150 was paid for the service. Your insurance will pay $120, which is 80%, and you’ll have to pay $30.
Payment options
When you get a bill in the mail, you have a lot of ways to pay it. Pinnacle Medical Wellness has payment plans and ways to pay online, by mail, or over the phone. You can also use these benefits if you have a Health Savings Account (HSA) or a Flexible Spending Account (FSA). You can pay with your plan’s card or get reimbursed.
Conclusion
Now that you understand your benefits and how much of the bill you’re responsible for. You can’t avoid medical costs, but you can handle them. Get a handle on your costs and make a plan so that you can get the care you need. Use your provider’s experience dealing with health insurers to your advantage. Ask questions and take the initiative to figure out what your benefits are.
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