Insurance

• 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. It is the responsibility of the patient to know their Physical Therapy insurance benefits, plan coverage, deductible, co-insurance and copays responsibilities.

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

• Does PRS offer a Payment Plan?
  Professional Rehabilitation Services is required to collect the estimated portion of the services rendered at each visit. We do not offer payment plans.
• Do PRS offer Self Pay?

  We offer self-pay to patients that do not have medical insurance that pay for their services in full at the time of service. We also offer self-pay options to patient's if their yearly insurance PT benefits exhaust. Please call our office for more information and to determine if your PT benefits have exhausted for the year.

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

• Do you accept Workers' Compensation Claims?

  Yes, we accept most Worker's Compensation insurance. This also varies by state. We do not accept W/C for NY and Ohio etc. at this time. Please call our office for more information. We must be in contact with a case manager and have an authorization on file for visits and date range prior to being seen at any of our locations.

  We will need the following information to get authorization prior to your first visit:

  • The Name of the Insurance Carrier
  • Your Date of Injury
  • State of Injury
  • Adjuster's / Case Manager - 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 $2.00 processing fee for each credit card transaction. This Credit card fee is not reimbursable.
• Why does my receipt show I have a credit?
  All monies paid at time of service are only estimates and are held on the account until your insurance processes claims. The monies are then applied to the claims that processed from your account .
• 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 each claim balance, and it may not cover all of your claims. It will decrease the total amount you will have to pay at 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. If you have a balance on your account / statement, we have applied all the estimated monies collected upfront and applied to your account. This is the balance after all monies have been applied for the months statement until the balance is paid in full.

  Note: Your balance on your statement may not include any pending insurance claims out to insurance that have not processed yet. We only bill monthly for the claims that have processed to date.

• 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 a 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?
  Your treatment for the services rendered will be determined at each visit and are based on the specific treatments performed at the time of service and codes billed. These may change at each date of service depending on your services and diagnosis(s) treated. PRS tries to give the best estimate based on your insurance verification.
• My Insurance Plan did not process according to the Verification of Benefits?

  PRS verified your benefits as a courtesy. The insurance benefit information that is given to PRS by the insurance company as stated by them can be erroneous and inaccurate and is not determined until the claim(s) are processed. This is why we urge the patient to call and get their Outpatient Physical Therapy benefits / responsibilities including visit limits, money caps, authorization needed and covered and non-covered services prior to services being rendered.

  PRS is not responsible for inaccurate information given by insurance company it is the patient responsibility to know their coverage, non-coverage, any pre-existing conditions that may not pay and their insurance benefits for Physical Therapy. Any balance incurred by the insurance claim processing or denial is the responsibility of the patient.

• 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 for covered, non-covered or denied services. We only get an estimated insurance benefits from your insurance. How the insurance processes is not known until insurance processes on what they cover or not cover for Physical Therapy services. All codes billed to the insurance plan are billable Physical Therapy codes.
• 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?

  PRS verified your benefits as a courtesy. The insurance benefit information that is given to PRS by the insurance company as stated by them can be erroneous and inaccurate and is not determined until the claim(s) are processed. This is why we urge the patient to call and get their Outpatient Physical Therapy benefits / responsibilities including visit limits, money caps, authorization needed and covered, non-covered services and the amount of monies that have paid / and have not paid yet for all related dates of services at another facility prior to services being rendered.

  PRS is not responsible for inaccurate information given by insurance company it is the patient responsibility to know their coverage and insurance plan for Physical Therapy. Any balance incurred by the insurance claim processing or denial is the responsibility of the patient. The patient needs to let PRS know where their coverage limits are prior to services rendered. All codes billed to the insurance plan are billable Physical Therapy codes.

  Any services that deny due the maximum(s) 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.

  Accident and Motor Vehicle Denials or Insurance refund requests - If PRS gets a denial / refund request of services provided due to an accident  (litigation case) or motor vehicle accident the patient will be responsible to pay the bill in full. We do not work with attorney’s or motor vehicle accident insurance at PRS.

  Pre-existing conditions / Cancellation & Non-payment of insurance premium- If there are any denials of payment from your insurance plan due to a problem with your insurance plan (cancellation / non-payment of premium / pre-existing conditions that do not pay) etc.   Once received the patient will be fully responsible for all charges for all dates of service where there is a balance due.

  Denial of claims do to requested information from patient from their insurance  company to pay claims not received will become patient responsibility. (ex: accident questionnaire / other insurance form request etc.) Once the problem(s) is resolved  we request you call our billing company and ask them to resubmit your claims. We only have certain time frame to bill claims to insurance once treated so any problems need to be resolved asap. If the timely filing limit is reached before we hear back from the patient, the patient will be fully responsible for all charges for all dates of service where there is a balance due.  If timely filing has expired claims cannot be filed.

• 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 Outpatient 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 determined at verification of benefits at each visit, which will be applied to your claims, 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 an estimated amount of $15.00 at each visit, the $15.00 will be applied to your claims, the amount per claim 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 and may change after claims process.

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

  We bill you monthly to collect any portions due the insurance has processed 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.

  All accounts statements not paid monthly will incur a 10.00 late fee added to the outstanding balance. After multiple statements and a final collection letter the account will be forwarded to the collection agency. If a patient's account goes to the collection agency PRS no longer deals with the account, the patient will need to call the collection agency to satisfy the balance.

• 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. The billing company may call the patient to help resolve issues with their insurance denials to help resolve. If a claim cannot be resolved it will be passed to patient responsibility.
• Who do I contact regarding my Physical Therapy bill or to review my account?
  If there are any account questions the patient can call our billing agency LRH Billing and Account Management at -(423) 727-7944.