INSURANCE BASED CARE
We know insurance benefits can be confusing. If you have any questions after reviewing this page, please don't hesitate to contact us. We are happy to assist you further!
WHAT YOU NEED TO KNOW
Your health insurance plan may require an order (referral or prescription from your doctor) before your they will cover the cost of your treatment. If you do not already have an order, you can call your insurance company to see if one is required. If an order is required, you will need to see your physician and get the order for physical therapy before making an appointment with us. You can bring the order with you at your first appointment, or your physician can fax the order directly to us.
In addition to the order for physical therapy, you will also need to bring your insurance card, including your secondary insurance if you have one, to your first appointment. If during your course of treatment your insurance changes, or you receive a new card, please notify us immediately. Changing insurance plans, and even renewing current plans, can result in changes to you physical therapy benefits. Failure to notify us may result in claims being denied.
We will bill your insurance company for the treatment you receive, but please be aware that you may be responsible for deductibles, co-payments, and co-insurance amounts. We know that insurance can be confusing and we will try to help you understand your specific physical therapy benefits, including your visit limit and financial responsibility. We will verify your physical therapy benefits at or before your initial visit, and review them with you so there are no surprises.
ACCEPTED INSURANCE PLANS
The list below is NOT all-inclusive. If you don't see your plan below, please email or call us with your insurance information. We will be happy to check with your plan to determine if we are in-network.
Anthem (Blue Cross/Blue Shield)
At Choice PT we believe a patient's needs should dictate the care they receive, not their insurance benefits. We simply will not allow your insurance company to influence the quality of care you receive. We will provide the treatment necessary to deliver optimal results regardless of insurance reimbursement or plan restrictions.
CONFUSED BY INSURANCE JARGON?
Here are some common terms and what they mean:
Patient Responsibility is a general term used for any amount the insurance requires you to pay for the services you receive. Your copayments, co-insurance, and deductible payments are all examples of a patient responsibility.
A "copay" is a set dollar amount that your insurance requires you to pay when you receive physical therapy. A copayment is a fix amount, meaning it will always be same at each PT session. The insurance company then typically covers the remainder of the cost for the session. If you have a copayment, you will be required to pay the amount every time you receive treatment.
Co-Insurance differs from a copayment in that it is not a fixed amount. Co-insurance is a percentage of the overall cost of each treatment session and will vary based on the services that are provided. For example, if you have a 20% co-insurance, and your treatment session cost $100, then you would owe $20, and the insurance company would cover the remaining $80. If you have a co-insurance, you will be required to pay it every time you receive treatment.
A deductible is the amount you have to pay before your insurance will start covering the cost of your medical treatment. For example, if you have a $1000 deductible, your insurance will not cover the costs of medical treatment until you have paid $1000 out-of-pocket. Any medical treatment (MRI, doctor or specialist visit, etc.) you pay for will typically go toward your deductible until it is met. Once your deductible is met, your financial responsibility will switch to a copayment or co-insurance. Deductibles do not always apply to physical therapy services, meaning you may only have a copayment or co-insurance even if you deductible has not been met.
The out-of-pocket maximum is basically a cap on the amount of money you will have to pay for medical treatment during a plan year. Once your out-of-pocket maximum is met, your insurance will pay for 100% of your medical costs the remainder of the plan year. The amount you spend on copayments, co-insurance, and your deductible all go toward satisfying your out-of-pocket maximum. Once your out-of-pocket maximum is met, 100% of your physical therapy treatment should be covered by your insurance.
Health insurance plans operate on a 12 month cycle. Every 12 months your existing insurance plan will terminate and you will be required to renew the existing plan, or switch to a different plan. This 12 month cycle is called a Plan Year. Most insurances have a plan year that coincides with the calendar year, running from January through December. However, some insurance plan years do not. Knowing your plan year is important as it may influence your decision on when and how you utilize your physical therapy benefits.
Most insurance companies restrict the number of physical therapy treatment sessions they will cover in a plan year. This is referred to as your visit limit. Visit limits typically range from 20 visits to 60 visits per plan year. Once you meet your visit limit, your insurance will not cover additional treatment. There are a few insurances that do not have a visit limit, but instead require proof of "medical necessity." Medical necessity means both your healthcare provider and insurance company must agree that treatment is needed. Physical therapy benefits determined by medical necessity typically require pre-authorization prior to starting treatment and at regular intervals during treatment.
At or after your initial evaluation, we may be required to get authorization from your insurance company to begin treatment. This is called pre-authorization and is common with Anthem, Humana, United Healthcare, and some TriCare plans. Pre-authorization may also be required to continue treatment past a certain visit limit. We will handle all pre-authorization requirements for you to ensure you have access to the benefits you need.
Procedures or services not covered by your insurance plan are called Non-covered Services. Even though non-covered procedures and services can be beneficial in your treatment, many clinics will not perform them because they won't get paid for their time or supplies. At Choice PT, we will not allow your insurance to dictate your care. You will receive the treatment you need, regardless if the procedure or service is covered by your insurance.
STILL HAVE QUESTIONS?
If you have questions about your insurance plan that you would like to have answered prior to making an appointment, please don't hesitate to contact us. We are happy to answer any questions you may have.