Per-Visit Cap (Paramedical)

The per-visit cap is the maximum amount your insurance plan will reimburse for a single visit to a paramedical provider, such as a physiotherapist, chiropractor, or massage therapist. If the provider charges more than the cap, you are responsible for the difference. This cap ensures fairness and cost control by aligning payments with typical local pricing.

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For example, your plan might pay up to $40 per visit for massage therapy, regardless of the therapist’s actual fee. The cap may apply before coinsurance is calculated, meaning the insurer reimburses a portion of that capped amount.

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Example:

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If your massage therapist charges $75 and your plan’s per-visit cap is $40 with 80 percent coinsurance, the plan pays $32 (80 percent of $40) and you pay $43.

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What to Watch For:

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Ask your provider about their fees before treatment. Some plans set different per-visit caps for various practitioners, and higher charges are always your responsibility.