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Welcome to Transformative Pain Care and Physical Therapy
We are excited to be a part of your health and wellness journey, and we want to help you feel empowered to make the right decisions for you and your family. Here are some answers to the most common questions we get.
Do you take my insurance?
What you really want to know is: How will my physical therapy visits get paid for? How much will be coming out of my pocket? And how soon will that happen? We will answer all of these questions.
This is a “cash-based” Physical Therapy clinic. We do accept Medicare, but are currently out of network with all other insurances. Our office does not have a Billing Department, therefore, we do not provide billing services in house. This also means that we do not have negotiated rates to be “in-network” providers with any insurance companies. Because of this, we accept payment at the time of service, and technically do not “take your insurance.” That said, any billable services CAN still be processed by your insurance company as an “out-of-network” provider if you submit those claims yourself (we will provide you with a superbill). Each insurance company is different in their reimbursement for out of network care and you should take the time to find out what they will pay.
Why a cash-pay clinic?
The number one reason we are a cash-pay clinic is because WE CHOOSE TO WORK FOR YOU, not the insurance company. Our aim is to give you the most valuable physical therapy experience available, and we believe our value lies in our interaction with you as a patient and not in convincing insurance companies to pay for the care you deserve.
Under this model, each visit is yours. You pay for our time and expertise and therefore YOU get to decide what we can provide for you that is most helpful to your goals and recovery. We can discuss your major complaints, your concerns both big and small, and your goals. Then we can build a comprehensive plan to get you where you want to be, doing what you love.
With this mindset, we can make each visit about what you want to work on. We can incorporate whatever combination of care that will get the best results. When we work for you, we don’t have to ask permission from your insurance on whether they will cover a treatment that is most APPROPRIATE for you, WHEN it is most needed by you. This can save you unnecessary visits, paperwork, questionnaires, and valuable time.
How much does Physical Therapy cost?
In most medical offices, you don’t know how much it's going to cost until you get a bill in the mail a month or two later. Our goal is to be as transparent as possible. You know what you’re getting, what you’re paying for, and what it costs upfront. No surprises.
Initial Evaluations 60-75 minutes: $200.00
Follow-up Visits 45-60 minutes: $200.00 (discounted packages available) - payment due at time of treatment (or in advance when a package is purchased)
Dry needle session only 15 minutes $50.00 (discounted 5 visit package available)
What are my payment options?
We accept all major credit, debit, HSA and FSA account cards using Square to process electronic payments. We also accept cash, check, PayPal and Venmo transactions. Upon request, we can provide an electronic receipt or superbill that can be submitted to your insurance for independent reimbursement and processing purposes. Please let us know up-front if you plan to submit a superbill, so we can stay current with each visit, but that said, we can generate a superbill at any point in the same calendar year.
What is a Superbill?
A superbill is just a medical term for a receipt. Unlike a credit card receipt (which you can also request upon payment) a Superbill provides insurance companies with specific medical coding information that they need to process a claim and distribute reimbursement. Essentially, a superbill is an itemized list of all services provided to you, our client.
A superbill typically includes information regarding our clinic, the patient, and the specifics for dates of service. This includes but is not limited to; diagnosis codes, current procedural terminology (CPT) codes, time administered, and occasional modifiers.
How that works:
Generally, when a medical office “takes your insurance,” this means that the healthcare provider has an established relationship with your insurance company and is on a list deemed as an “in-network” provider. Often this means the provider will accept a set co-pay rate (based on your plan) at each visit, and will then send the remaining billable services to your insurance company for processing.
Based on your specific plan, your insurance company will process the claim. In processing the claim, usually 1 of 2 things happens.
1. The claim will be denied.
2. The claim will be accepted, and you will be billed for some percentage of the services associated with your date of treatment.
In the case of a denial, there is often a detail or formatting error in the claim submission that needs correction, or additional paperwork that is required to reprocess the claim to meet the insurance company’s particulars. Occasionally companies require physician referrals, preauthorization, or questionnaires completed to prove progress or definitions of medical necessity. These issues are typically cleared up directly with a representative from your insurance company.
In the case of successful claims, most insurance companies will require some payment from you for billable services until you reach your yearly deductible and/or out-of-pockets maximums. Any payments made by you are then applied to your plan limits. Whether you pay for visits in full or in part is based on the in-network or out-of-network rates negotiated by your insurance company, and the codes billed by your healthcare provider.
Usually a quick web search or simple phone call to your insurance company can tell you what you need to do to submit your own claims. The physical therapy services you pay for in our office can be filled and processed under your plan. Once your insurance processes your claims, reimbursement will be sent directly to you.
Don’t see your question or still have other queries? Get in touch for more information.
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