Due to the large number of insurance companies, the time to process insurance claims, the variety of plans, and the differing costs associated with different treatments, it is impossible for us to know exactly what each insurance plan will or will not cover. We can estimate your responsibility by contacting your insurance company at the time of your initial visit. You will be given or mailed a postcard with the coverage information your insurance company gives us, but ultimately it is your responsibility to know your policy and what it covers. We encourage you to call your insurance service representative (the phone number is usually on the back of your insurance card) and ask the following questions:
Do I need pre-authorization for physical therapy?
Do I have to be referred by a PCP (primary care physician)?
Do I have a deductible1? If so, how much is it?
Do I have co-insurance2? If so, what is the percent that I have to pay?
Do I have co-pays3? If so, how much are they?
What are the limitations of coverage (time, dollar amount4, etc.)?
We are able to bill most of our patients’ primary insurance companies. We will also bill your secondary insurance if we are contracted providers or if Medicare is primary. Once we process your claim from them, you will be sent a monthly statement updating you on the amount that is your responsibility. However, our policy is that if we have not received any payment from your insurance within 60 days of your first visit you are then completely responsible for your bill. (You will then need to submit your own claims to your insurance company and be reimbursed by them directly). Remember, if you have a co-pay, Washington State law requires us to collect it at each visit. Note: Some plans may not require a referral, you may contact your specific plan to clarify.
Jackie, our billing manager is available on Wednesday and Friday. Feel free to contact her with any billing questions or concerns. Our office coordinators are also very knowledgeable and often able to assist you.
1 The amount you will need to pay before your insurance company starts paying. (e.g. $500)
2 The ratio of what your insurance company will pay and what you will pay. (e.g. 80%/20%)
3 The amount you must pay at the time of each visit. (e.g. $15)
4 Often insurance companies have a maximum amount they will pay toward PT. (e.g. $2500)