PAYMENT INFORMATION

In a direct-pay treatment model, the physical therapist provides clinical treatment based on the need of each individual without third party insurance reviews, network restrictions and visit limits. Physical therapy services are provided in a manner that both parties have determined will help to reach treatment goals most efficiently.

Documentation for evaluations, treatment visits, and progress notes are performed just like a standard physical therapy practice and comply with all legal requirements. The patient pays at the time of service, allowing the therapist to focus attention on providing the best possible service while keeping administrative costs low. You may pay for services using cash, check, credit or debit card, HSA or FSA account.

Some insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide some payment for services received “out of network.” Going out of network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. Many patients choose to receive services out of network in order to see the physical therapist of their choice.

The end goal of documentation and billing is the same – delivering on commitment – it’s just that, in the case of direct-pay services, it is the patient who is submitting the insurance claim and will be reimbursed rather than the provider. We recommend speaking with your insurance company prior to beginning with us if you are planning to submit for reimbursement.

The payments you make may or may not be reimbursable by your insurance company under your out-of-network physical therapy benefits; the exact percentage depends upon your plan. You are responsible for determining what your benefits are and obtaining any necessary physician referrals and/or pre-authorizations for services. We are not responsible if your health plan denies, in whole or in part, your claims for our services. If you have out-of-network benefits, Healing Calm Physical Therapy will provide you with an invoice at the time of service, and you may at your discretion submit that invoice and receipt to your insurance company for potential out-of-network reimbursement. The invoice has all of the necessary information (business name and address, tax ID, national provider identification, license numbers, etc.) as well as the ICD-10 (diagnosis) and CPT (billing) codes. You may choose to submit bills following each visit, one time per month, or at any other interval that is convenient for you.

Outpatient physical therapy services are generally covered under Medicare Part B, provided the service is considered medically necessary to treat a disease or condition. Under current Medicare regulations, physical therapists are not allowed to accept direct pay from Medicare beneficiaries for services that may be covered under Medicare, even if the services provided meet all treatment, documentation, and HIPAA requirements and have been prescribed by their physician.

Since we are not Medicare enrolled providers, we cannot submit claims to Medicare and Medicare will not pay for our services even though the same services might be paid by Medicare if you obtained them from a Medicare enrolled provider. In some cases, a Medicare beneficiary may pay cash for services that are no longer considered medically necessary, for example a “maintenance” or “wellness” program. Medicare may also allow cash payment for services beyond the Medicare cap for therapy services. If you are interested in learning more about whether we are able to offer you our physical therapy services for your current condition please call the office.

In many cases, the out-of-pocket expenses for a course of physical therapy will actually be LESS for services provided at Healing Calm Physical Therapy. In large part, this is due to the ability to charge less per visit, with these charges being well below the national average charge submitted to insurance in a typical outpatient practice.

On average, most patients have insurance deductibles of $5,000 or more. The average PT clinic bills insurance $250 per session, the cost of which is the patient’s responsibility until they meet their deductible.

We keep our treatment prices affordable while providing exceptional care. Healing Calm Physical Therapy can charge less because the simplified direct-pay fee structure streamlines billing and does not require hiring billing personnel or paying fees to a third-party billing service. This allows us to focus all energy on patient care, and allows patients to make informed decisions regarding the costs of their health care choices.