This is the total amount you must pay out-of-pocket before your insurance starts to pay. For example, if your deductible is $1,000, then your insurance won’t pay anything until you have paid $1,000 for services subject to the deductible (keep in mind that the deductible may not apply to every service you receive). Furthermore, even after you’ve met your deductible, you may still owe a copay (fixed amount) or co-insurance (percentage amount) for each visit.
This is a fixed amount that you must pay for a covered service, as defined by your health plan. Copays usually vary for different plans and types of services. Typically, you must pay this amount at the time of service. Again, copay amounts are fixed—which means you will always pay the same amount, regardless of visit length. In most cases, copayments go toward your deductible.
This type of out-of-pocket payment is calculated as a percent of the total allowed amount for a particular service. In other words, it’s your share of the total cost. For example, let’s say:
- Your insurance plan’s allowed amount for an office visit is $100.
- You’ve already met your deductible.
- You’re responsible for a 20% coinsurance.
In this situation, you’d pay $20 at the point of service. The insurance company would then pay the rest of the “allowed” amount for that visit. Keep in mind that the coinsurance amount may vary from visit to visit depending on what services you receive.
Medicare Part B patients are responsible for a 20% coinsurance, which typically amounts to $11-25 per visit. If you have original Medicare as your primary insurance, but you also have a secondary insurance, the secondary payer becomes responsible for the 20%. In some cases, the secondary insurance also charges a copay, coinsurance, or deductible. We recommend contacting your secondary insurance carrier to find out.
If you have not yet met your deductible, then you will be responsible for the full cost of each visit until the deductible is met. Typically, this amount can range anywhere from $50-$135 per visit. We charge coinsurances as a dollar amount equal to the percentage of the full amount for the visit. You’ll then owe any applicable coinsurance or deductible balances after we receive the Explanation of Benefits (EOB) from your insurance company. Conversely, if we find that you have overpaid, we will refund you via check as soon as possible. As for copays—these amounts rarely vary, so if your copay for physical therapy visits is $10, you will owe $10 at each visit.
Your health is our number-one priority. As such, we are happy to arrange a payment plan that works with your budget. That way, you can pay for your care over a timeframe that works for you. Simply ask to speak to our office/billing manager.
If I don’t want to use my insurance, can I just pay for services myself?
The self-pay rate for all visits at Southern Rehab and Sports Medicine is $85. If the patient chooses the self-pay option, we will not bill their insurance and the amount paid for treatments will not go toward the deductible.
Our Physical Therapists (PT’s) and Physical Therapist Assistants (PTA’s) are licensed by the state of Alabama, Tennessee and Georgia.
We believe that we can provide you with the highest quality of care available and do it in a cost-effective manner. You will work closely with your physical therapist. Your case will be managed by the same physical therapist from the beginning to the end of your experience with us.
In most cases, you have the right to choose any physical therapy clinic. Our practice is a provider for many different insurance plans. Simply give us a call and we will attempt to answer all of your questions.
During your first visit you can expect the following:
- When you arrive for your appointment, you will complete some important paperwork. You may download the forms from our website: see the paperwork or forms link.
- You will need to provide us with your prescription for physical therapy.
- We will copy your insurance card and identification.
- You will be seen for the initial evaluation by the therapist.
- The therapist will then formulate a list of problems you are having and how to treat those problems. An individualized plan is subsequently developed for each patient. This plan is created from your input, your therapist and your doctor.
The therapist will discuss the following:
- Your medical history.
- Your current problems/complaints.
- Pain intensity, what aggravates and eases the problem.
- How this is impacting your daily activities or your functional limitations.
- Your goals for physical therapy.
- Medications, tests, and procedures related to your health.
The therapist will then perform the objective evaluation which may include some of the following:
- Palpation – touching around the area of the pain/problem. This is done to check for the presence of tenderness, swelling, soft tissue integrity, tissue temperature, inflammation, etc.
- Range of Motion (ROM) – the therapist will move the joint(s) to check for the quality of movement and any restrictions.
- Muscle Testing – the therapist is checking for strength and the quality of the muscle contraction. Pain and weakness may be noted. Often the muscle strength is graded. This is also part of a neurological screening.
- Neurological Screening – the therapist may check to see how the nerves are communicating with the muscles, sensing touch, pain, vibration, or temperature. Reflexes may be assessed as well.
- Special Tests – the therapist may perform special tests to confirm/rule out the presence of additional problems.
- Posture Assessment – the position of joints relative to each other may be assessed.
The therapist will then formulate a list of problems you are having, and how to treat those problems. A plan is subsequently developed with the patient’s input. This includes how many times you should see the therapist per week, how many weeks you will need therapy, home programs, patient education, short-term/long-term goals, and what is expected after discharge from therapy. This plan is created from input from you, your therapist, and your doctor.
Make sure you bring your physical therapy referral (provided to you by your doctor), your payment information and identification such as your driver’s license.
If your insurance is covering the cost of physical therapy, bring your insurance card.
If you are covered by Workers’ Compensation, bring your claim number and your case manager’s contact information. If you are covered by auto insurance or an attorney lien, make sure you bring this information.
You should wear loose fitting clothing, so you can expose the area that we will be evaluating and treating. For example, if you have a knee problem, it is best to wear shorts. For a shoulder problem, a tank top is a good choice. For low back problems, wear a loose fitting shirt and pants.
Billing for physical therapy services is similar to those at your doctor’s office. When you are seen for treatment the following occurs:
- Our charges are based on CPT (Common Procedure Terminology) codes.
- Codes are transferred to a billing form that is either mailed or electronically communicated to your insurance company/ payer.
- The payer processes this information and makes payments according to an agreed upon fee schedule.
- An EOB (Explanation of Benefits) is generated and sent to you and Carolina Physical and Sports Medicine with a check for payment and a balance due by you.
- You are expected to make payments on the balance, if any. Installment plans can be arranged through our billing office.
As a courtesy, when you arrive at our office, a staff member will gladly assist you with contacting your insurance carrier to obtain your coverage and benefits information.
Each patient’s coverage can be different. It is ultimately the patient’s responsibility to know and understand their insurance coverage.
There should be a toll free number located on the back of your insurance card to call and obtain your benefits coverage for outpatient physical therapy.
We gladly accept Cash, Check, Money Orders, Visa and MasterCard.