Insurance

At Professional Rehabilitation Services, we are in-network providers for most major insurance plans. As a courtesy to our patients, we will contact your insurance company to verify your benefits prior to your appointment. We will bill your insurance(s) and file your claims electronically, in a professional and timely manner. We will assist you in any way so that you may promptly receive the care you deserve and need.

In order for us to best serve you, we recommend that you contact your insurance company(s) directly to know your physical therapy benefits. To verify your PT benefits: Download the Patient Insurance Worksheet then bring the insurance worksheet with you on your first visit.

• Why is it important to know my insurance benefits before my first physical therapy appointment?

  Any benefit information given to us by insurance companies is sometimes erroneous and inaccurate. We urge you to call your insurance company for complete details on your physical therapy benefit responsibilities including both covered and non-covered services.

  To verify your PT benefits: Download Patient Insurance Worksheet. Then, bring the insurance worksheet in on your first visit.

• What if I need a Payment Plan or am undergoing Financial Hardship?

  Professional Rehabilitation Services offers programs to those who are undergoing any financial hardships and qualify based on HHS poverty guidelines issued by the government, upon completion of a financial hardship application. In cases of financial issues, we will gladly consider payment plans. Please let us know prior to the first visit if you need either one of these options to see if you qualify.

• Do you offer Cash Therapy Programs?

  We offer cash programs to self-paying patients that pay for their services in full at the time of service. In addition to those patients that do not have medical insurance, self-pay patients also include those that are opting out of their insurance generally because of high deductibles, and co-pays. Please call our office for more information.

  Note: Charges for each visit will vary depending type of services are provided. Payment is due at the time the services are provided.

• Do you accept Workers' Compensation Claims?

  Yes, we will need the following information to get authorization prior to your first visit:

  • The Name of the Insurance Carrier
  • Your Date of Injury
  • Adjuster's Name and Phone Number
  • Claim Number
• What are your Payment Options for estimated insurance, responsibility, etc.?

  We accept cash, personal checks, Visa and MasterCard. There is a $1.00 per transaction fee for each credit card transaction. This is not reimbursable at any time.

• Why does my receipt show I have a credit?

  All monies paid at time of service are only estimates and are held on your account until your insurance processes your claims.

• Will the money I pay up front at every visit cover all my expenses?

  The money you pay at each visit is an estimated portion going towards your ending balance, and it may not cover all of your expenses. It will decrease the total amount you will have to pay in the end. This is a way to decrease the chance of having a financial burden on you and your family after you have completed treatment.

• I do not understand why each date of service has different charges on my receipt? How are physical therapy services coded / billed?

  Insurance companies require that we itemize every procedure we perform. Each procedure has a numeric code (CPT Code) and a specific charge according to our fee schedule. Many codes are "time dependent" and billed in increments. Since many treatment sessions last an hour there may be 4 different billing codes submitted for a single visit and the codes will depend on what was performed / done at your therapy visit. For approved PT services, insurance reimbursement varies according to individual plans. You should refer to your "Explanation of Benefits" for details.

• Will I know the exact dollar amount I am being charged prior to treatment?

  No, your charges will be determined after each visit and are based on the specific treatments performed and codes billed. You may contact your physical therapist to discuss any questions you may have.

• Will I be responsible for any services my insurance denies?

  Yes, all services provided must be paid in full by either your insurance plan or yourself.

• If there is a maximum dollar amount my insurance will pay for therapy per year? I was treated at another facility, will my therapist be made aware of this?

  It is the patient's responsibility to call their insurance company and obtain the amount of monies that have paid out related to all dates of services at another facility and let us know where their coverage is at. Any services that deny due the maximum reached will be the patient's responsibility as we are unable to know the exact charges incurred prior to services rendered by us. Insurance will not provide us information related to another facility.

• Will my insurance cover everything at 100%?

  This will depend on your Physical Therapy Benefits. You may be responsible for any co-pay, co-insurance and deductible. Please call your insurance for your Physical Therapy coverage.

  If your insurance states they provide 100% coverage of services there may be services which are non-covered under your plan. These specific services can't be determined until your claims have been processed by your insurance company. When we verify your benefits we obtain plan coverage. However, we are not always aware of services that will be denied by your insurance plan. All codes billed to your insurance are billable physical therapy codes.

• What is the difference between a Co-pay, Coinsurance and Deductible on my insurance plan?

  If you have a deductible:
  A deductible is an amount determined by your insurance plan that you the patient will be responsible before the insurance will pay towards the claim.

  For example:
  If you have a $250.00 deductible this would mean you are responsible for $250.00 of the allowed charges before your insurance will start to pay. Therefore, we ask you, the patient, to pay an estimated portion of your deductible at each visit, which will be applied to your ending balance, which is determined once your insurance processes your claims.

  If you have coinsurance:
  A coinsurance is a percentage determined by your insurance plan that you the patient will be responsible for once the insurance has processed the claim. This normally goes into effect once a deductible (if any) has been met

  For example:
  If your coverage is 90/10 this would mean you are responsible for 10% of the allowed charges. Therefore, we ask you, the patient, to pay $15.00 at each visit, the $15.00 will be applied to your ending balance, which is determined once your insurance processes your claims.

  If you have co-pay:
  Co-pay is a set dollar amount determined by your insurance plan that is due at each visit.

  For example:
  If your insurance plan requires a per visit co-pay of $15.00, this will be required each time you are treated.

  Note: During the therapy process you may be responsible for all of the above so an estimated portion will be collected based on insurance verification of benefits.

• When will I get a statement for the amount I owe?

  We bill you on a monthly basis to collect any portions due at that time and make you aware of the status of your account. You will receive a bill each month for any portions owed until all dates of service have been processed and paid. Any balance due on your statement is due within 30 days to avoid a $10.00 late fee. If you have a credit on your account for amounts paid upfront you will not receive a statement until your credit has been exhausted.

• If I have a refund on my account when will I receive my refund?

  Any account balances that are overpaid from upfront estimated payments will be refunded after we have received all insurance processing for all treated dates of service and the payments have been posted. Please allow 30-60 days for primary insurance and up to 120 days or longer for multiple insurances. If there are denials or problems with your insurance it may take longer to receive your refund as we do not issue refunds until all claims have been resolved and processed correctly. If a claim cannot be resolved it will be passed to patient responsibility.