The Billing Process: Your Costs
*SelfPay rates are provided to patients who are not using insurance benefits must be paid at the time of service.
Visit
Meet with and have your first PT appointment with Specht Physical Therapy.
Charges
Specht Physical Therapy will file insurance claims with charges on your behalf. Charges are based on Services Rendered (CPT codes) at each visit. NOT amount paid by you.
Insurance
Your insurance will adjust the amount depending on your plan & contract with Specht Physical Therapy. Any balance not paid/adjusted by your insurance company becomes your patient responsibility.
Patient Responsibility
Through an explanation of benefits (EOB) the patients and Specht Physical Therapy are notified about the portion of the claim that will be paid by the patient.
Deductible Not Yet Met: $65-75 Per Visit & Monthly Statement
A $65-75 Pre-Payment towards your deductible is collected at each visit (Depending on insurance) and you will be billed any remaining balance.
OR
Deductible Met:
Copay or Co-Insurance
A Predetermined Rate or Percentage you are responsible for based on your specific Health Insurance.
Feel Better. Perform Better. Keep Moving.
Understanding a Deductible Plan
FOR EXAMPLE: You have a $2000 deductible that must be met before your Insurance covers $100%. We normally collect $50 per visit as a Pre-Payment towards your deductible to offset a large bill at the end of the month (or service).
Initial Evaluation
Visit #1
You paid $120 at the visit
After Charges have been adjusted by Insurance, Patient responsibility is $155 for that visit (an example).
$35 still owed for visit
Follow Up Appointment
Visit #2
You paid $65 at the visit
After Charges have been adjusted by Insurance, Patient responsibility is $75* for that visit (an example).
$10 still owed for visit
Follow Up Appointment
Visit #3
You paid $65 at the visit
After Charges have been adjusted by Insurance, Patient responsibility is $70 for that visit (an example).
$5 still owed for visit.
*Please note the cost of each visit may differ depending on the services, treatment or activities provided at the visit. Your first visit, the Initial Evaluation, will most likely be more expensive due to the complexity of the examination.
| Date of Service | Charges After Insurance Adjustment | Initial Patient Payment | Remaining Balance Due |
|---|---|---|---|
| Visit #1 | $155 | $120 | $35 |
| Visit #2 | $75 | $65 | $10 |
| Visit #3 | $70 | $65 | $5 |
| $300 Total Charges | $250 Pre-Paid | $50 Due |
$50 would be billed at the End of the Month
Explanation of your Statement
Please find below an example of our monthly statement you will receive each month until your balance is paid in full. It shows the charges for services rendered, the amount your insurance company has paid, patient payments made in the past 30 days, any amount still under consideration by your insurance company, and the amount you should pay now. A glossary of terms appears below.
Glossary of Terms on Statement
Term Used / Category and Explanation
Date:
Date of Service.
Charges:
Amount charged for services rendered and/or items provided, sent to Insurance. NOT Patient amount.
Pat. Payments:
Payments made by patient since the last statement and/or applied to the particular dates of service. This includes any copayments or co‐insurance payments at time of visit. Your single payment may be applied to more than one date of service if the total of the payment is larger than patient amount due for a single date of service.
Ins. Payments:
Payments made by insurance company or third party payor per patient benefits.
Adjustments
Amount not allowed due to insurance contractual agreement. This amount is subtracted from the charges for the date of service.
Total Balance:
Current balance of open insurance claims and patient responsibility.
Pending Insurance:
Balance awaiting insurance claims processing.
Patient Responsibility:
Patient’s financial responsibility (i.e. amount owed) for date of service(s).
Total Due From Patient Balance:
Patient’s financial responsibility due now.
