California Physical Therapists may see patients without a referral from a physician for 12 visits, or 45 days, whichever comes first. If physical therapy services are deemed medically necessary after that grace period, the patient will need to provide us with documentation of a physician's diagnosis for the problem for which they are being treated. In most cases, insurance companies will require a prescription from a physician for all care covered by the insurance company. Therefore we will only be able to evaluate and treat patients without a prescription/diagnosis from a physician on a Cash Pay basis and only for the term of the grace period.
For those patients who do not have billable insurance, or who wish to be seen without a physician's prescription, we provide services on a cash pay basis. Our current cash pay rates, as of June of 2015, are as follows: $160 for the one hour evaluation $80 for a 30 minute follow-up session $120 for a 45 minute follow-up session $160 for a one hour follow-up session Please check with our office to ensure that these rates still apply.
INSURANCE Insurance companies are notorious at providing us with misinformation about our patient's plans. We highly recommend that you contact your insurance directly to see if we are contracted with them. You may call our office and get our tax ID number.
We are contracted as In-Network providers for the following insurance plans:
• Medicare • Blue Cross PPO * Blue Shield if employer based* • Blue Cross/Blue Shield PPO* • HealthNet PPO • many other PPO plans • Worker's Compensation
* Blue Cross/Blue Shield is different than either stand alone Blue Cross or Blue Shield. We are contracted with stand alone Blue Shield in most cases if you are insured by your employer but not if you are insured as an individual (not through a company).
We are contracted as Out-Of-Network providers for the following insurance plans: • Aetna • United Health Care • Cigna We apply a substantial 25% reduction of our fees for these three networks.
We are not contracted with any HMO plans. We are not contracted with Medicaid.
UNDERSTANDING YOUR INSURANCE CONTRACT
It is important to understand your payment responsibility for the physical therapy services that you will receive at SOS. You will be responsible for your deductible and for your co-insurance or co-payment. Each of these amounts varies according to your contract with your insurance company. You will also be responsible for any charges for services that exceed your benefit limit or for services that are denied as not medically necessary. It is your responsibility to know your insurance benefits for outpatient physical therapy. We will be happy to assist you with ascertaining your coverage benefit but we cannot guarantee the information that is provided to us by your insurance company. Some insurance coverage requires an authorization before beginning physical therapy. We recommend that you contact your insurance at the contact number which is listed on your insurance card. We can provide you with our tax ID number.
The following articles are helpful in learning the definition of these terms and how they apply to health insurance payments: