Frequently Asked Questions
About Billing, Fees, Insurance, Reimbursement,
In-Network vs. Out-of-Network Benefits, etc.
I use a professional billing service and I will bill your insurance as a courtesy. Each insurance company may have tens or even hundreds of different plans, so I encourage patients to review their policy and coverage. Most plans have a deductible, which you must meet before your plan pays for services. The deductible is the amount you must pay out of pocket. Please check with your plan to determine what your deductible is, and how much of that deductible you have met to date. Deductibles must be met yearly, and not always by the calendar year. Some plans have limits as to how much physical therapy they will cover in a year. Again, please check with your insurance for your plan details; each plan is unique.
Are you in my insurance company’s network?
I am a Blue Shield Preferred Provider. I am not a Blue Cross Provider, as they charge providers upwards of $8,000 per year for the privilege of reimbursement of about 30 cents on the dollar. In order to afford this expense and poor reimbursement, “In-Network” plans typically use a managed care model where the licensed Physical Therapist may see you for a small portion of your visit, and then a non-licensed aide supervises the remainder of your appointment. You are billed for the treatment regardless of whether or not it is performed by a fully trained, experienced and licensed therapist. This is not the type of treatment I provide or wish to provide. In my practice, I alone provide care for my clients during their entire appointment.
What does this mean to you and your recovery?
Unlike most patients who are limited to the traditional “In Network” programs, your evaluation and treatment plan is completely customized to your needs, and therefore more efficient and effective. Your care and recovery from injury can therefore, in most cases, be managed faster with fewer visits.
Do I need a physician’s prescription?
State law allows me to evaluate your problem, but especially with regard to insurance reimbursement, you should have a prescription from your physician for continued treatment. The prescription can be from your family physician, OB/GYN or any medical doctor, or from your chiropractor.
Do you give a discount for cash paying clients?
Yes. If you pay me with cash, credit card or check at the time of the visit, the fee for initial evaluation is $140, and follow-up visits are $115. I will give you a “SuperBill” receipt for the visit, which you may submit to your insurance company for your reimbursement.
How much treatment will I need?
Each patient and problem is unique, so that’s a tough call. If you have had long-standing pain or dysfunction, you may need more treatment than someone with a new ache or pain. Once I evaluate you, I will be able to give you a better idea about your treatment plan, including prognosis, duration and frequency of treatment.
What will we do in the initial evaluation?
I will go over your complete medical history and talk with you about the behavior of your symptom/s. We will review any film studies such as XRays, CT or MRI scans, as well as discuss previous treatment (successful or not) and any other areas of pain or limitations. Most importantly, we will discuss your goals for treatment. I will then perform a physical examination, including strength and flexibility testing, and then we will formulate a treatment plan according to all of the above. Lastly, we will initiate treatment, and usually start instruction related to a home program.
