Payment and Insurance

Questions

  1. Do you accept my insurance?
  2. Is Physical Therapy Covered by my insurance?
  3. How can your front office staff help me?
  4. What information do we need from you?
  5. When will I receive a bill?
  6. I don't have insurance coverage, but need physical therapy what are my options?
  7. What do the insurance and billing terms mean?
  8. What frequency and duration is appropriate for treatment?

Answers

  1. Do you accept my insurance?

    Our facilities and providers are contracted with most major insurance companies and many workers’ compensation insurances. We are happy to bill your insurance as a courtesy to you and will assist you in determining whether your insurance benefits will cover our services.

  2. Is Physical Therapy Covered by my insurance?

    Because all individual plans vary in restrictions and requirements, we encourage you to contact your insurance company to understand the extent of coverage you may have available for physical therapy. It is important to be aware of any limitations that your insurance plan entails such as:

    • Any unmet deductible
    • Co-pay or co-insurance amounts
    • Pre-authorization requirements
    • Visit limits (annual)
    • Maximum dollar amount in coverage
    • Primary Care Physician limitations
    • How can I find this information?

    Call the contact number that is listed on your insurance card, or go to the payer’s website and register your account. Ask for specific Physical Therapy benefits and verify any of the above requirements.

  3. How can your front office staff help me?

    After you make an appointment with one of our clinics, we will be contacting your insurance company to verify your benefits and do our best to understand your specific coverage limitations. We’ll provide you with a copy of this summary of information at your first appointment. Keep in mind that these are the benefits quoted to us by your insurance company which are subject to changes beyond our control.

  4. What information do we need from you?

    We strive to provide top notch customer service by communicating to you any insurance coverage issues that may arise. However, health insurance benefits can be complicated and confusing. To minimize this, we need your correct insurance information, address and phone numbers. We ask that you alert us with any concerns, problems and changes as they arise.

    We appreciate your understanding that any patient co-pay, or estimated co-insurance, and deductible responsibility will be made at the time of service and remaining patient payments will be made promptly after receiving your statement.

  5. When will I receive a bill?

    As a courtesy, we will bill and assist in obtaining payment for the physical therapy services you receive. It typically takes between 45 and 90 days for you to receive a statement.*

    Upon receiving services, our central billing office bills your insurance and works directly with your insurance company for processing.
    Potential issues and benefits limitations are facilitated through this process.
    Insurance company acknowledges receipt of and processes your claim.
    You will typically receive an EOB (Explanation of Benefits) from your insurance company.
    Insurance company informs the billing office of the “allowable amount” for your services and processes your claim accordingly.
    Central billing office will issue your statement for the amount that your insurance company assigns as your responsibility.
    Depending on your length of care, your monthly statement may or may not include all dates of service. Each visit will be listed on the statement.
    You can pay your balance due online, by check, credit card, or by calling our billing office at 866-387-7778. You can also make a payment on your account by visiting the clinic you were treated in.
    *Please note that circumstances beyond our control can often delay billing. If your insurance company denies benefits, inaccurately processes your claims, or delays the acknowledgement of your claims, we will strive to inform you any time we identify the problem.

  6. I don't have insurance coverage, but need physical therapy what are my options?

    We offer a cash rate program for those clients without insurance coverage, or for services rendered outside what your benefits will cover. Please contact your nearest clinic to inquire about our cash rates and any other options available.

    If a third party is liable for your injury, please contact your nearest clinic for a review of your circumstances to determine how we may be able to assist you.

    For Billing, Account, and Payment Related Questions: 866-387-7778

  7. What do the insurance and billing terms mean?

    Below are some of the more common insurance terms that you may encounter.

    Co-Payment: This is the amount the insurance company requires the patient to pay on the day of service.

    Deductible: A Deductible is the amount you pay out of your own pocket before your insurance begins picking up any portion of the costs of health care. The amount of a deductible will vary from one policy to the next so be certain that you know about that before you select a health insurance policy. Deductibles are typically based on yearly health care costs and may include a different amount for families. For example, you may have a $500 per person deductible. That means you’ll pay the first $500, regardless of whether the first office visit costs that much or you make ten visits at $50 per visit. Your policy may also include a “per family” amount which means that you combine the costs for everyone in the family rather than meeting a deductible for each family member.

    Allowed Charges: An “allowed charge” is the amount an insurance company considers for services received by their client that are provided by an in-network provider. The in-network contract we have with an insurance company requires us to accept the “allowed charge” for any services provided.

    Co-Insurance: Your contract may state that you are required to pay a percentage of the allowed charges. For example, you may have an 80% – 20% plan, which means that the insurance company will pay 80% and you will pay 20% of the allowed charges.

    In-Network Benefits: These are the benefits your insurance company will consider if we have a contract with them. After the insurance company receives our bill for services rendered, they will determine the allowed charges they will pay for each service. We are bound by our in-network contract with the insurance company to accept their determination of allowed charges.

    Out of Network Benefits: These are the benefits that your insurance company will consider if we are not a preferred provider, or directly contracted, with them. The patient may be responsible for a higher portion of the total bill.

     

  8. What frequency and duration is appropriate for treatment?

    In general, most patients with musculoskeletal conditions attend physical therapy 2-3 times a week on non-consecutive days. Length or duration of care is dependent on many variables including patient age, diagnosis, fitness level, severity of injury, and more. On average, patients are seen in therapy for 3-6 weeks.

    If you are unsure of the most appropriate frequency and duration, the physical therapist can make a recommendation based on their evaluation findings. You can also put an initial frequency and duration on the prescription. If the therapist feels more or less therapy is appropriate, they will communicate this with you.

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