Per-Visit Maximum
A per-visit maximum is the highest dollar amount your insurance plan will reimburse for a single appointment or treatment with a healthcare provider. If the provider charges more than this set amount, you are responsible for paying the difference. This type of limit is most common in extended health plans for paramedical services, such as physiotherapy, chiropractic care, massage therapy, or acupuncture.
Per-visit maximums help insurers control costs while still offering flexibility to access a range of practitioners. The limit applies separately to each visit, and reimbursement is typically based on the lower of the provider’s fee or the plan’s maximum, multiplied by your coinsurance percentage.
Example:
If your plan allows a per-visit maximum of $40 for massage therapy with 80 percent coinsurance and your therapist charges $70, the insurer reimburses $32 (80 percent of $40) and you pay the remaining $38.
What to Watch For:
Always confirm the per-visit maximum before booking an appointment, as each paramedical discipline may have its own limit. Some plans also apply both a per-visit and an annual maximum, so reaching either cap can stop further reimbursement for the rest of the benefit year.
