Who pays for Physical Therapy?

In most cases, health insurance will cover your treatment. We take major private insurance plans, including Medicare, Workers Compensation, etc. If your insurance is managed by an HMO or IPA, a valid and current authorization is required prior to your first visit.  If you do not have insurance coverage, you may come in as a cash patient.  Please call our office to ask about our rates.


Do I have to pay any portion?

This will depend on your insurance policy.  Depending on your insurance, you can have none to one or more of the following:


1)  Copayment:  This is the amount that is due for EACH visit.  Copayments are determined by your insurance carrier, not your medical group or your physical therapist.  Copayment amounts printed on your insurance card usually reflect the copayments for your primary care physician and other specialists.


2)  Deductible:  Deductibles usually apply with a PPO or Medicare plan.  A medical deductible is similar in idea to a car insurance deductible.  Your deductible is the amount that you must pay the provider's office before your insurance will begin to pay for services.  Deductibles are cumulative for the insurance year.  Each payment that you make to your provider is deducted from the total deductible amount.


3)  Coinsurance:   Coinsurance and copayments are not the same.  Coinsurance is also determined by your insurance plan and is usually represented by a percentage of the charges.  For example:  If you have a coinsurance of 20%, this means that your insurance company will pay 80% of the allowable charges (once your deductible has been met) and you are responsible for 20% of the allowable charges.


Example 1:  Your physical therapy copayment is 15 dollars and there are no deductibles and no coinsurance.  This means that your responsibility is 15 dollars to your provider for EACH visit.   Your insurance will pay the remainder of the charges if there is a valid authorization for physical therapy.


Example 2:  If your insurance benefits are:  500 dollars deductible with a 70/30 plan.  This means that you are responsible for the first 500 dollars of allowable charges.  Once you have paid the 500 dollars to your provider (cumulative amount from all you providers), the insurance benefits take effect.  In this case, the insurance will pay the provider 70% of the allowable charges and you are responsible for the remaining 30%.