Insurance & Billing

When you call to schedule your first appointment, we’ll ask you for your insurance information. Then, as a courtesy to you, we will call your insurance company to verify your benefit coverage and we’ll review this information with you before you begin your first visit.

In addition, we encourage you to call your insurance carrier to find out your physical therapy and/or occupational therapy benefits provided by your medical plan prior to your visit.

Finally, we will promptly file your claim with your insurance company on your behalf so you won’t have to worry about having to fill out any other forms.

Billing for physical therapy services is similar to what happens at your doctor’s office. When you are seen for treatment, the following occurs:

• The physical therapist bills your insurance company, auto carrier, or charges you based on Common Procedure Terminology (CPT) codes.
• Those codes are transferred to a billing form that is either mailed or electronically communicated to the payer.
• The payer processes this information and makes payments according to an agreed upon fee schedule.
• An Explanation of Benefits (EOB) is generated and sent to the patient and the physical therapy clinic with a check for payment and a balance due by the patient.
• The patient is expected to make the payment on the balance if any.

*It is important to understand that there are many small steps (beyond the outline provided above) within the process. Exceptions are common to the above example as well. At any time along the way, information may be missing, mis-communicated, or misunderstood. This can delay the payment process. While it is common for the payment process to be completed in 60 days or less, it is not uncommon for the physical therapy clinic to receive payment as long as six months after the treatment date.

At the beginning of each month, we issue statements of your account showing account activity for the previous month. The statement shows your dates of service (DOS), the amount you have paid, the amount your insurance or third party payer has paid, the amount pending claims processing, and your patient responsibility amount. VIEW SAMPLE STATEMENT AND GLOSSARY OF TERMS HERE

Patient balance is due within 10 days after you’ve received your statement and/or no later than the 25th of the month. Your balance will reflect the portion of your bill that the patient is financially responsible for paying. When your insurance company has processed the claim for your treatment, we are notified through an explanation of benefits (EOB) about the portion of the claim that will be either paid by insurance or will not be paid for by insurance because it is part of your deductible or part of your co-insurance responsibility. Any balance not paid for by your insurance company becomes part of the patient responsibility amount that you will be expected to pay.

If your treatment dates of service occurred in two different calendar months, your first statement may show only those visits from the first calendar month and your patient responsibility amount for visits during that first month. Please be sure to pay your statement balance due upon receipt of each statement.

You will receive a statement whenever your account has balance due.

Payments can be made online here, mailed in with the statement, or called in to the office. All major Credit Cards and checks are accepted.

Accounts are continuously reviewed. Patient accounts with balances greater than 90 days with no outstanding/open insurance balance are subject to being sent to a third-party collections agency. Courtesy calls/emails will proceed any information sent to collections.

Premium: A monthly payment you make to have health insurance. Like a gym membership, you pay the premium each month even if you don’t use it, or you lose coverage. If you’re fortunate enough to have employer-provided insurance, the company picks up all or part of the premium.

Copay: Your copay is a predetermined rate you pay for health care services at the time of care. For example, you may have a $25 copay every time you see your primary care physician, a $10 copay for each monthly medication and a $250 copay for an emergency room visit.

Deductible: The deductible is how much you pay before your health insurance starts to cover a larger portion of your bills. In general, if you have a $1,000 deductible, you must pay $1,000 for your own care out-of-pocket before your insurer starts covering a higher portion of costs. The deductible resets yearly.

Coinsurance: Coinsurance is a percentage of a medical charge that you pay, with the rest paid by your health insurance plan, after your deductible has been met. For example, if you have a 20% coinsurance, you pay 20% of each medical bill, and your health insurance will cover 80%.

Out-of-pocket maximum: The most you could have to pay in one year, out of pocket, for your health care before your insurance covers 100% of the bill.