WHAT IS CASH-BASED PHYSICAL THERAPY?
In a cash-based treatment model, the physical therapist enters into a contract with the patient (not an insurance company) to provide physical therapy services in a manner that both parties agree will help reach treatment goals most efficiently. This model allows the physical therapist to focus on providing the best possible care to the patient, and eliminates unnecessary administrative costs. Payment is made at the time of service with cash, check, credit card, debit card, or health care savings account (HSA) card.
The cash-based treatment model eliminates confusing medical bills and allows for clarity in decision making on the part of the patient and their physical therapist. You know exactly what services you are paying for and the amount you are paying. Documentation for evaluations, treatment visits, and progress notes comply with all legal requirements.
CAN MY INSURANCE BE BILLED FOR CASH-BASED PHYSICAL THERAPY SERVICES?
Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide payment directly to the patient for services received "out of network". In this model 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. With cash-based services, it is the patient who is waiting for reimbursement from the insurance company rather than the provider.
RESTORE PHYSICAL THERAPY’S THERAPIST IS AN OUT OF NETWORK PROVIDER - WHAT DOES THIS MEAN?
This simply means that the therapist has not entered into a contract with individual insurance companies to receive reimbursement based on their contracted rates. There are MANY insurance companies, each with their own contracted rates and regulations, and Restore Physical Therapy’s energy is best spent working with patients—not insurance companies. It is important to note that in network provider status is not based on education, experience, skills, or treatment outcomes, but is often determined by the number of providers in a demographic area.
WILL I END UP PAYING MORE FOR CASH-BASED PHYSICAL THERAPY?
Most often the total out of pocket expenses for physical therapy will be LESS for services provided at Restore Physical Therapy than at a practice where insurance is directly billed. Restore Physical Therapy’s cash-based fee structure streamlines billing and eliminates administrative costs. Your physical therapist at Restore Physical Therapy can focus on the patient care you need, not on what insurance may or may not allow. The patient can make informed decisions regarding the costs of their health care.
HOW DO I FIND OUT MY INSURANCE BENEFITS FOR OUTPATIENT PHYSICAL THERAPY?
Complete the Insurance Benefits Worksheet, which will help you determine your physical therapy benefits.
WHAT STEPS ARE INVOLVED IN SUBMITTING A CLAIM TO MY INSURANCE COMPANY?
Restore Physical Therapy will provide you with an invoice at the time of service, and you may submit that invoice to your insurance company for reimbursement. The invoice has all of the necessary information (business name and address, tax ID, national provider identification, PT license number etc.) as well as the patient’s 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, typically up to one year following your treatment visit.
MY INSURANCE PROVIDER IS MEDICARE (or a Medicare Product).
CAN I BE TREATED AT RESTORE PHYSICAL THERAPY?
Restore Physical Therapy is not an enrolled provider with Medicare, and patients cannot be reimbursed by Medicare for visits at this clinic. (Under current Medicare regulations, it is illegal for a physical therapist to accept cash pay from Medicare patients 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.) Please call 541-908-7959 if you have questions.