Understanding Medical Insurance & Physical Therapy Benefits

Date Published: July 29, 2022

If you are reading this, you are probably hoping for a light at the end of the tunnel that is medical insurance. Let us help you walk through some of the major insurance questions! First, so that we don’t waste time reading this whole blog, we are currently in network with:

  • Aetna PPO
  • Anthem Blue Cross PPO
  • Blue Cross/Blue Shield PPO
  • United Health Care PPO
  • Cigna PPO (American Specialty Health)
  • Medicare Part A/B (non-HMO)
  • AltaMed HMO
  • Tricare (Active and Retired Military)
  • Worker’s Compensation (OneCall, Corvel, Medrisk, Onsite Physio)

If you are not in network with any of these insurances then unfortunately we will not be able to use your insurance for billing purposes. However, we pride ourselves on offering the most competitive and affordable cash/non-insurance rates in the physical therapy industry. We feel all prospective clients deserve access to affordable healthcare. That being said, we offer physical therapy services to individuals without insurance or those who elect not to use insurance for $75.00 per visit.

*Exception*: Medicare patients
For Medicare patients please see the “What if I have Medicare?” portion of this blog as many of the items discussed in the PPO portion DO NOT apply to those covered by Medicare.

What does my insurance cover?

Insurance coverage all depends on the specific insurance plan you choose or those assigned to you by your employer. With most insurance plans, you will have a copay, deductible, or co-insurance, or some combination of all three. A copay is a flat rate for all costs of services, which is shared by your insurance. This is a fixed payment that is due with each physical therapy or doctor visit. These copays will differ based on who you are seeing (e.g. a physical therapist vs. primary care physician). In our office the copay will be collected upon arrival with the card on file that you provide during the intake portion of your first visit.

Clients who have a deductible must meet their deductible before insurance starts to assist with payment for your visits. This means that all visits are paid out of pocket by the patient until you have met that deductible. Deductibles range anywhere from $0-$8000 for most insurances that we see, and are dependent on your specific insurance plan. Many people with a high deductible plan (e.g. $2000+ may also include an HSA/FSA account that is used to help offset the out of pocket cost). You will always have the option to use your HSA/FSA card as your card on file until the account runs out of funds.

Once you have met your deductible, generally one will have a coinsurance. From what we have seen with our clients, coinsurances can range anywhere from 0%-45%. This percentage is the amount the patient is responsible for paying, and the remaining balance is covered by your insurance. For example if a patient has a 10% coinsurance and the claim is $150, the patient is responsible for paying $15.00 and the insurance company will handle the remaining 90% balance.

When paying toward a deductible or coinsurance, it is not a requirement to pay on the same day as your service. For this reason, we offer a variety of payment options at Accelerate Physical Therapy. For those with a deductible or coinsurance plan, one can elect how they wish to be billed for their services. The patient can elect to pay as they go and be billed on the day of services or a patient statement can be mailed to your home address when the claims are returned through insurance. We also offer a payment plan, in which statement balances can be broken up into three payments over the span of two months. Although there are sometimes high costs associated with healthcare, we want to give you the most extensive and easiest options for payment.

What if I have Medicare?

For Medicare patients we accept Medicare PPO as well as secondary insurance coverage. This means that the patient is not in an HMO or Independent Physician Association (IPA) group with Medicare and they can elect whichever provider that they wish to see. As a Medicare patient you will have an annual deductible which typically increases every year. The annual deductible for Medicare in 2022 is $233. This means all medical services are out of pocket until $233 in claims is reached. At Accelerate a Medicare patient will typically meet their deductible in one to two visits. Once the medical deductible is met, Medicare covers 80% of all medical bills. The remaining 20% is either paid by the patient directly or is covered by a secondary insurance of their choosing. Be sure to note that the secondary insurance plan may have a deductible. If the secondary plan chosen has a deductible, the cost will be out of pocket to pay for that remaining 20% until the deductible is met. From what we have seen, secondary insurance deductible’s range anywhere from $250-$1500. If your plan has a deductible, understand that you will receive a patient statement in the mail.

But I don’t remember what insurance plan I chose?

Medical insurance is at times confusing and like most insurance you will rarely get a direct answer with your questions. Most of the information you need to know on your plan is typically written on your insurance card. If you are not sure about your plan and what you are responsible for, you can call the 800 number on the back of your card to find out what your plan entails. Typically this will connect you to an automated response system which will inform you of deductible balances, out of pocket maximums, and what you have paid or contributed toward your plan for the current year. You also have the option of navigating the insurance provider website which will give you the option to log in and check your benefits and plan. Many of the health insurance companies also offer an App that you can download to your phone to determine information on your plan and which providers are in network.

I don’t have insurance, am I still able to come in for treatment?

Absolutely! We want to get you access to our services in as many ways as possible! Our non-insurance rate or cash rate is currently $75.00 per session. We also offer a package of 6 visits at $70/visit and 12 visits at $65/visit; these are paid in full at the time of your initial evaluation. At Accelerate Physical Therapy we make sure that we are staying competitive in the business but give people the opportunity to get the care they need without breaking the bank. We also provide an at home exercise program with more self-management for those who need continued care but cannot afford our services. Please note that we are legally not allowed to treat those who are covered under Medicare as a non-insurance patient, medicare patients must use their insurance for all visits.

I’ve paid so much in medical bills this year, does it ever end?

Yes, it actually does end! Every medical plan has an out-of-pocket maximum. Patients can find out their out-of-pocket max when they call the number on their card, or visit their insurance company website. This number is generally higher than a deductible, anywhere from $2000-$12,000 depending on your plan. Once the patient has met their out of pocket max, insurance will cover every medical bill for the rest of the insurance calendar year as long as it is in network with the patient’s plan.

We hope that this helps you understand how insurance works a little more. If you have more in depth questions about insurance we highly recommend calling your insurance company and asking them for clear answers. We will always give our patients’ cost information prior to their appointment so that they know generally how much they will be responsible for! If there are any questions feel free to email our office at [email protected] and our Client Care Coordinator will happily get back to you as soon as possible.

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