Billing and Insurance

Why is insurance not filed at Physical Therapy Rehabilitation Specialists?

Insurance is not filed because the Business Model necessary for an insurance-based practice does not support the Treatment Model that I follow. What does that mean?  Therapists in clinics that bill insurance have to see at least two patients per hour (sometimes more) and use technicians to apply multiple modalities like ultrasound and e-stim. They do this because most insurance companies reimburse about half of what they bill. I do not believe that modalities are nearly as effective as my hands, and I also do not agree with having patients pay to perform exercises in the clinic that they can easily perform at home. In many ways, insurance companies dictate or at least influence the treatment that the patients receive at the clinics, which in some instances can compromise the quality of care the patient receives.  I refuse for that to be the case at Physical Therapy Rehabilitation Specialists. Each of my patients receives an hour of one-on-one, hands-on treatment, which is one of the reasons the results are so much faster than average. When considering the time savings of less trips to the clinic and the value of resolving your pain so much faster than the average clinic, the out of pocket expense at Physical Therapy Rehabilitation Specialists is a huge bargain.

Can I bill my insurance for reimbursement of my out-of-pocket expenses?

This depends on the insurance you have, but yes, most patients can get reimbursed for their treatments. You should be able to print claim forms off of your insurance company's website, and send it in with the needed receipts and treatment codes that will be provided upon request at the clinic. The amount of reimbursement is completely dependent upon your insurance plan. If you call your insurance company to inquire, you should ask about "out-of-network Physical Therapy" expenses. Below is a step-by-step guide and instructions on how to get reimbursed for your Physical Therapy treatment.

Payment/insurance policy

Technically we are a "fee for service" practice and do not process any insurance claims. We accept all cash/check and all major credit cards. Payment is due at the time of service.

Why?

Physical Therapy Rehabilitation Specialists is a patient care centered practice and recognizes that certain policies of insurance companies are geared to make collections more difficult and limit payment to increase their profits, thereby compromising the future of rehabilitation. We believe that patients should understand their individual insurance policy and therefore take responsibility for getting reimbursed according to their plan.  Eliminating us from the insurance collection process will not allow treatment to be influenced or compromised by the insurers and improves the quality of care with direct one-on-one treatment.

What does that mean for you?

A. Non-Medicare patients: pay for services the day they are rendered and will be given the necessary forms and receipts to submit for direct reimbursement for the service. Please read on how to determine your insurance benefits on the form/worksheet "How to determine your insurance Benefits for Physical Therapy."  Please also read suggestions for submitting your insurance claim below.

B. All Medicare patients: to include those with Medicare advantage/replacement plans, must pay for services the day they are rendered. Due to a governmental complication, as of this date, physical therapists cannot "un-enroll" from Medicare, prohibiting you from submitting your claim for reimbursement. 

Suggestions for submitting your insurance claim/reimbursement from your insurance

Follow these step by step directions to guide you through reimbursement of your insurance claim for Physical Therapy:

1. Reimbursement for physical therapy is based upon your out-of-network benefits/coverage. The Insurance Benefits worksheet can assist you in determining your out-of-network coverage, please look it over and fill it out so you understand your benefits. You can reach your insurance carrier by calling the Customer Service number on the back of your card. If you did not have an opportunity to utilize the Insurance Benefits worksheet on the form "How to Determine Your Insurance Benefits for Physical Therapy" and need us to assist you, please feel free to contact us via phone or email. You can also download the Insurance Benefits worksheet on our webpage.

2. Once you are familiar with your out of network benefits and claims procedure, you can submit your first claim. Most insurance companies require that you complete a general claim form. This is usually a basic form with your name, address and policy number. Most can be accessed and printed from your insurance company's webpage. 

Print the claim form so you can create a template for submitting multiple claims. Create a template by completing one claim form without signature or date. Then make copies of this template and keep them on hand. Each time you submit a reimbursement receipt, you must also submit a claim form. Sign and date the template claim form for the current date of service you received treatment. Also, submit the comprehensive receipt you received from Physical Therapy that day. It is imperative that you send both of these forms each time in order to receive reimbursement.

For anything on the claim form regarding charges, units of time, type of treatment, CPT codes, ICD9/diagnosis codes, make a notation on the claim form of “see attached’ as our comprehensive reimbursement receipt is inclusive to all of these items. Our reimbursement receipt also clearly states that your physical therapy is outpatient physical therapy, and that any and all reimbursement checks are to be sent directly to you, the patient. We strongly suggest that you make this clear on your claim form as well.

3. Clarify where to mail or fax your claims with your insurance company. Please note most insurance companies have a time limit with regard to claim submission. Please call the Customer Service or Claims number on the back of your insurance card to learn what deadlines your insurance company has for submitting claims. 

Do I need a prescription, script or physician's referral?

No. A prescription or referral for Physical Therapy is not required; you can call us to make an appointment right now. Having quick and immediate access to Physical Therapy can be the difference from your condition being acute or temporary and chronic. You do not need to wait a week or more to be seen by your primary care physician or orthopedic specialist prior to being seen in our office. We encourage you to call us immediately if you experience an injury or have pain.

Arizona is one of the 44 states that permit Direct Access for Physical Therapy. This means that you do not need to wait weeks to see your physician or specialists to begin treatment with Physical Therapy. Your therapists will work closely with your physician or health care provider in the coordination of your treatment so that you can concentrate on healing. Your Physical Therapist does not provide a medical diagnosis, however we will perform a thorough evaluation and determine your movement impairment diagnosis and relay this information to your physician or healthcare provider with your consent.

Do you accept Insurance?

We are a fee-for-service clinic and accept cash, checks and all major credit cards. You pay for the treatment the same day we see you in our office and your payment may be reimbursed by your insurance provider. The fee for the initial one-on-one one hour session with Sarah Hanna, PT, MPT is $72.00, and your one hour follow up is $60.00. Discounted rates and fees are available for those who are experiencing financial hardship or financial limitations. Special rates are available for single mothers and those who are experiencing work transitions. Sessions that are 15 minutes including spinal manipulation are $25.00, 30 minutes sessions are $40.00. 

What are the benefits for using a fee-for-service physical therapy clinic?

Many insurance companies and plans have high in-network deductibles and co-pays.  Having one-on-one treatment sessions with specialized and effective manual therapists allows patients to heal quickly and understand what they need to do to stay healthy.  This specialized treatment allows care to be expedited and for costs to stay low.  In many instances the cost for treatment at a fee-for service clinic can be lower than many insurance deductibles, which is ultimately less out of pocket costs.  Additionally, some of the fees that Physical Therapy Rehabilitation Specialists provides for 30 minute sessions are lower than some insurance company co-pays.