We participate with all insurance companies and are in network providers for most. Please feel free to contact our office regarding your specific insurance plan. In today’s health care, coverage for physical therapy varies greatly with the type of insurance you have. Many require pre-certification for physical therapy. Prior to your first visit we will call your insurance company to ascertain your particular insurance coverage and/or requirements. We will advise you of this information before you start therapy and we will make every effort to comply with your insurance companies requirements to ensure proper coverage. Whatever the case, we do the billing for you!
In general, coverage is as follows…
We are a Medicare certified facility. Medicare has a deductible then generally covers 80% of approved charges. The patient is responsible for the balance. If you have secondary coverage with Medicare, they will often pick up a percent of Medicare’s approved charges after that. Some are billed directly by Medicare after Medicare has paid their portion while others have to be billed separately, with a copy of the Medicare explanation of benefits (EOB). Again, we do this for you.
Health Maintenance Organizations (HMO’s):
If we are “in network” for your Health Maintenance Organization (HMO), they usually have strict pre-certification requirements and limits on the amount of physical therapy they will cover. They usually have a co-pay. If we are not “in network” for your HMO, but you have “out of network privileges” you can still get coverage. In this case, you may have a deductible in addition to co-insurance. Each program varies therefore we coordinate with your insurance carrier prior before you start physical therapy to verify your exact coverage and any requirements.
Preferred Provider Organizations (PPO’s) & Point of Service Plans (POS):
In general, PPO and POS plans have less strict pre-certification requirements and allow more coverage for physical therapy. They generally have a co-pay if “in network”, co-insurance and deductible if “out of network”. Again, each program varies therefore we coordinate with your insurance carrier prior before you start physical therapy to verify your exact coverage and any requirements.
Traditional insurance companies generally have no pre-certification requirements. Patients generally pay a deductible and then a percentage of charges (i.e., 20%). As always, each program varies therefore we coordinate with your insurance carrier prior before you start physical therapy to verify your exact coverage and any requirements.
In the State of New Jersey, workers compensation has the right to direct your care. Therefore, although you may express your preferences, they must approve your choice of physical therapy services which is done in conjunction with the physician. Workers compensation then covers physical therapy charges at 100% of the negotiated rate and the patient is not responsible for charges.
Auto No Fault:
Physical therapy is covered under Auto No Fault. However, they do require a physician’s referral and have pre-certification requirements. Patients are typically responsible for a deductible and co-insurance. We will verify your benefits for you prior to your starting physical therapy.
Unfortunately, the Federal Government does not allow Medicaid patients to be treated in an independent out-patient facility.
Regardless of your insurance type, we submit bills to your insurance carrier for you. We ask that you pay your co-pay, deductible, and/or co-insurance at each visit unless other arrangements have been made. We accept cash, checks, Discover, MasterCard and Visa.
We make every effort to verify benefits and notify patients of their responsibility at the time of treatment. Final determination of payment is made by your insurance company upon receipt of the claim. Patients are ultimately responsible for payment of their claim and by assuming responsibility you will demand the best and that is what we expect to give.
I just wanted to personally thank you for your March 31, 2010 evaluation regarding our patient. You clearly communicated your concerns regarding this patient which helped the doctor make his determination regarding surgery. Without your effort, the outcome of this patient’s injury could have been disastrous. The doctor has decided against surgery and placed the patient at MMI. Please let Barry know that his FCE was also key to clarifying the picture on this claim. Without the two of you, we would be looking at a very different scenario.