Deductible is amount of money that a member must pay upfront before they will receive benefits from their insurance. This typically resets with the 1st of the year, but some insurances may have a different operating year. You must check with your insurance company to understand when each new year’s deductible begins and ends. Until the amount of your deductible has been payed to any providers that you or your child see, therapy will not be paid for by insurance. You may have both a family and individual deductible; whichever is met first takes precedence.

A percentage that must be paid by the member after the deductible has been met.  This is your shared responsibility with your insurance carrier. 

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Please note deductibles, copays, and coinsurance typically have different amounts if you see a provider in your insurance network or out of network. Typically amounts will be much higher out of network. Optech is holds contracts as an in network provider for MOST major insurance plans. We “accept” Out-of-Network insurances but at out of network benefit rates. Call us for details on your specific plan.

Many members also have an “out of pocket maximum” within their plan that, when met, may negate further bills. This means that once you have paid out of your own pocket towards deductibles, co-insurance, etc. the insurance might pay in full. 

If pre-certification is required, our staff will work on getting the required approvals for coverage. In some cases you will need to work with us and your doctor to get these approvals in place.