INSURANCE AND BILLING

INSURANCE AND BILLING INFORMATION

Scroll down for registration forms.

We are out-of-network with all private commercial insurance.

We do not accept assignment of benefits for any insurance company, including Medicare and Medicare Advantage Plans. Therefore, all patients are expected to pay for their visit in full on the day of their appointment. YOU WILL BE REIMBURSED by your insurance provider based on your plan's coverage and benefits.

Medicare will reimburse 80% of our charges. If you carry a Medigap insurance it will reimburse the remaining 20%. Your Medigap insurance might not cover your yearly Medicare deductible. Please check with your insurance provider for specific details related to your policy.

For Medicare Advantage Plans, you will be reimbursed approximately 95% to 100% of our charges. Each Advantage plan is different. Please check with your particular plan to confirm the exact percentage of reimbursement applicable to your coverage.

You will receive an explanation of benefits from your insurance company once they have processed our claim. We advise that you keep the explanation of benefits for future reference in case you have any questions or concerns about your reimbursement.

Please be aware that it takes 4 to 6 weeks for insurance reimbursement. If you have not received reimbursement for a visit, six weeks after the visit, please contact us for assistance.
Any Insurance reimbursement accidentally made to us will be refunded to the patient.

The state of California allows for direct patient access for physical therapy services, A doctor's referral is not needed in order to be seen for physical therapy services under the following guidelines:

If you are a cash pay patient, you can be seen by a physical therapist for 12 visits, or six weeks, whichever comes first, without a doctor's prescription.
If you need continued treatment beyond that period then you would need to get a prescription from your doctor.
Medicare, Worker's Compensation and some other forms of insurance require a doctor's prescription for treatment.

Columndelete

MEDICARE AND MEDICARE ADVANTAGE PLANS

We are non-participating providers who do not accept assignment for Medicare and Medicare Advantage Plans.

What does this mean for you, as a patient receiving our services?

We bill both Medicare and Medicare Advantage Plans for our services.
Because we do not accept assignment of benefits, our patients are reimbursed directly by Medicare and by their Medigap plan, if any.

To date, Medicare Advantage Plans continue to reimburse us directly. We are working to change this so that they reimburse our patients directly, as they should.

Our status with Medicare as non-participating and not accepting assignment allows us to collect the full allowed amount for our service plus a 15% excess charge at the time of service.

On your Medicare explanation of benefits this allowed amount plus the 15% excess charged is called the coinsurance. The amount listed as coinsurance should equal the amount that you pay for your visit.

Medigap plans are identified as plans A through N.

Please check to see if your Medicare deductible is covered by your plan.

Some, but not all, Medigap plans cover the 15% excess charge.

Medicare claims statements

There's a quicker way to see and save your Medicare claims statements besides waiting for the explanation of benefits in the mail.

You can get your Medicare Summary Notices (MSN) electronically.

It's easy to switch to electronic Medicare Summary Notices.

First, create or log into your secure Medicare account at Medicare.gov/account and select "Edit my account settings."
Next, under the "Document settings" section at the top of your account settings, select "Edit" next to Medicare Summary Notices (MSNs), and choose "Electronically."
Then, for each month you have claims processed, you'll get an email letting you know your Medicare Summary Notice is available to check in your Medicare account.

Column

PRIVATE COMMERCIAL INSURANCE

We are contracted as Out-Of-Network providers for all private commercial insurance.
As out of network providers, we collect the full amount of our services at the time of service.

The charge for our evaluation is $307. We discount this charge to $264 for our private commercial insurance patients.

The charge for our follow up visits ranges between $129 and $172.

Because we do not accept assignment of benefits our patients are reimbursed directly for any contributions made by their insurance company.

Some forms of insurance require pre-authorization for treatment.

CASH PAY

Our current cash pay rates are as follows:
$240 for the one hour evaluation
$160 for a 30 minute evaluation
$105 for a 30 minute follow-up session
$165 for a 45 minute follow-up session

$210 for a one hour follow-up session

Cash payment can sometimes be a less expensive option if you have a large deductible.
Cash pay services are billed with a different coding system than insurance services. Insurance companies will not accept our cash pay codes. If you plan to submit your physical therapy services for insurance reimbursement you will not be able to use our cash pay option.