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Health Savings Accounts & Flexible Spending Accounts for Physical Therapy Treatments
We have chosen to practice independently of managed healthcare networks. This allows us to spend the appropriate amount of time to fully examine, discuss all aspects of your disorder, and maintain a high quality of care. We do, however, believe in holding down costs in order to increase access to the level of care that our patients need and deserve.
Therefore, we are out of network with most insurance plans (we are unable to accept Medicare beneficiaries). Below are a few reasons we chose this route in order to better serve you:
We charge a flat fee for service. We do not bill your insurance. Considering insurance dictates what is reimbursed for physical therapy, we think people deserve advanced care at a reasonable price. Our prices are very fair and can potentially save you money with high co-pays, co-insurances and longer lengths of treatments needed elsewhere.
Decisions about your physiotherapy treatments will be made by you and your physiotherapist—not your insurance. Don’t let the middle man get in the way of you feeling better and moving better.
So you can think of this as PERSONAL physiotherapy—no technicians, no waiting around to just let someone point you to a machine—just ultimate service and highest product with you in a ONE on ONE setting. How much better do you think YOUR pain and life will be with this type of approach?
We would not be able to ensure the unique physical therapy experience we are committed to providing with insurance companies dictating how often, how long, and what you receive in therapy. In a typical PT clinic, it is not uncommon for you to be in therapy 2-3 times a week for 6-8 weeks. You most likely have a co-pay which must be paid at each and every visit. That adds up quickly. If you’re lucky, you will have reached your deductible. If not, you will be paying out of pocket for all those visits.
Other physical therapy providers that accept insurance are forced to see multiple patients within the hour, leaving you to do exercises on your own after only 15-30 minutes with the therapist. The personal experience is lost when your therapist is busy bouncing from patient to patient.
When compared to your deductible, co-pay, and co-insurance, you will end up saving money. At the end of the day, you’ll receive personalized care from a caring physical therapist, save time, and save money.
Your insurance typically has “out of network” benefits. We encourage you to call to determine if your insurance offers it.
The process is actually quite simple: PhysioFit of NC can provide you with a superbill for your appointment and you may submit that superbill to your insurance company for reimbursement. The superbill has all the necessary information (business name and address, tax ID, national provider identification, license numbers, etc.) as well as the patient’s ICD-10 (diagnosis) and CPT (billing) codes. You may choose to submit bills following each visit, one time per month, or at any other interval, typically up to one year following your treatment visit. This way the insurance company will pay you and not us, as you already paid us for the services. Please ask us if you would like a superbill for your services.
This is a difficult question and varies from person to person but let us explain. Our approach saves you time and can actually save you money.
Under the “standard” medical model, you are treated in blocks of roughly 15 minutes, deemed a “unit.” Each unit is priced separately. That means that exercise is a unit, hands-on-treatment is a unit, and so on. Typically, each unit is billed at a cost in the $60 range, adding up to $120 per 1/2 hour of care (or $240/hour). This happens everyday in every insurance-pay clinic.
Insurance providers use many tactics to pay as little as possible on claims, such as denying charges, insisting charges be re-coded, requesting re-evaluations every few visits, delaying payments and so on. Insurance adjusters (i.e. people who are not your physical therapist) limit the number of times you can be seen by your physical therapist, regardless of how you are progressing. Known as a “cap” this can be based on a cash-value or a number of visits. They also decide how much your insurance company will actually pay known as “allowable amount” (typically in the 40-60% range of the actual bill). So a 30-minute PT visit might be reimbursed at $70 and a 60-minute session might be between $100-130. Whatever you paid in copay or deductible is subtracted from that amount and the insurance pays the difference.
The claims process described above can take months. To ensure success in this process, your provider needs to hire extra employees to deal with billing, collections, and insurance company run-around. Their internal costs go up while their revenue is capped at what insurance will pay. The result is that your care with a physical therapist is limited (so the clinic can remain profitable and cover their overhead). With limited one-on one time with your therapist, you’ll likely need more visits to overcome your injury!
Each direct-pay visit is one-on-one contact with the PT (as opposed to the typical 20-30 minute model). Drs. Vaughans have the time to fully assess your condition(s), provide hands-on treatment and educate you and help you build a plan to get back to your life. By having extended time with each patient, they are able to provide faster results and better outcomes!
The average physical therapy insurance copay is $45/visit (but can range from $25-75/visit). If you need just 12-24 visits at a standard clinic, you are paying $600-1200 out-of-pocket and only getting 5-6 hours of one-on-one time with the PT. With that model, you are likely also going to PT 2-3 times a week – putting your cost at $100-150/week. Another concern is your time – while PT direct contact time is only 25-30 minutes, you’ll have exercises and modalities (traction/heat/ice) that extend your time in the clinic to 75-90 minutes. This adds up to 20+ hours of time out of your life for the duration of your recovery!
Our model gives you more hands-on care and requires fewer total visits. Rather than 2-3 visits per week to get an hour with the therapist, our treatment sessions mean that 1 visit per week is often all that is needed. This puts your out-of-pocket costs at a comparable $120/week. Instead of extending your visit time with exercises in the clinic, you will be given a home program and information to take with you – saving you precious time during your day. In the end, you’ll get better faster and be back to doing what you love sooner!
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