Patient’s overview to billing terminology

Deductible: Dollar amount the patient must pay towards medical expenses before the insurance will start to pay (this is similar to deductible due on an auto insurance plan or home owners plan)

Co-Insurance: a percentage (%) that the insurance pays and the remaining % patient must pay. Example: 80/20% split means that the insurance will pay 80% of the contracted allowed amount while the patient pays the remaining 20% . If the insurance allowable is $100.00 with an 80/20 split the insurance will pay $80.00 leaving the patient responsible to pay the remaining $20.00.

Copay: A set dollar amount the patient must pay per visit.

Out of pocket maximum: The full amount the patient must pay on their own before the insurance pays at 100%.

Medicare Therapy Cap: This amount changes every year based on Congress, for 2017 the Therapy cap is now $1980.00 for both physical and speech therapy combined. The cap represents how much Medicare will cover towards billed physical therapy services per calendar year.

Prior Authorization: This is when clinical information is submitted to the insurance company and the insurance company then decides how many physical therapy visits will be authorized in a given time frame.


"For a sophisticated and finest physical therapy and for the warmest and most effective encouragement you can't find a better guidance then at Pouzol Physical Therapy. "

- Ansley Throckmorton

"I highly recommend Teri Carr, PT. She is an extraordinary physical therapist and care giver. Her years of experience and constant continued learning make her an absolute expert. She is such a caring person and very effective. She works with her patients to find a plan that will work for them. She focuses on pelvic floor issues – including nerves in the pelvis. She is the only expert listed for the state of Maine for pudendal neuralgia. I am so lucky to have her as my therapist.

The staff here is also excellent. Everyone is upbeat and helpful, from the owner (Doug) to the support staff (Katie). I’ll never go anywhere else for physical therapy! "

- Robin T.

"Teri Carr and the crew at Pouzol's Physical Therapy have been extremely helpful with dealing with my health issues. The Pelvic Floor therapy for my abdominal pain has increased my quality of life twofold and when I had back issues last year Teri helped me with pre and post surgery pain and recovery. The atmosphere there is a place of healing and the people are all very friendly and I consider them as friends. I would recommend them to everyone and come to think of it I have. "

- Tammy Light

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