FREQUENTLY ASKED QUESTIONS
Frequently Asked Questions (FAQ)
How does being Private Pay benefit me as a patient?
The Private Pay model allows you to pay in advance or at the time of service, which allows your clinician to keep focus on you and your recovery. There is no paperwork or additional insurance issues to deal with.
How does pricing for ELEVATE Therapy services work?
After meeting and creating a Health Plan for your specific needs, we will discuss cost. This will consist of flat rates for each service and what you would like to add and remove as we go. In doing this, this gives you control over cost and services that you wish to have depending on your progress and health.
Are you limited to cash payments?
Although we do not work with insurance, we accept many forms of payment. You can pay with cash, credit, debit, check, Flexible Spending Accounts (FSA), Health Savings Accounts (HSA) and Health Reimbursement Accounts (HRA).
Can my insurance be billed for Private Pay Physical Therapy Services?
Most insurance companies, with the exception of Medicare, Medicaid and some HOMs, will provide payment for services received “out of network”. Going out of network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. many patients choose receive services out of network in order to see the physical therapist of their choice. The end goal of documentation and bill is the same – getting paid. In the case of cash-based services, it is the patient who is waiting for reimbursement rather than the provider.
Will I end up paying more for Private Pay Physical Therapy?
In many Private Pay cases, the out-of-pocket expenses for a course of physical therapy will actually be LESS for services provided by us. This is due to the ability to charge less per visit, with these charges being below the national average charge submitted to insurance in a typical in-network outpatient practice. We can charge less because the simplified cash-based fee structure streamlines billing and does not require hiring billing personnel or paying fees to a third-party billing service. This allow us to focus all energy on patient care and allow patients to make informed decisions regarding the cost of their health care choices.
What steps are involved in submitting a claim to my insurance company?
The process is simple: We will provide you with a “Statement for Insurance Reimbursement” or “Superbill” at the time of service, and you may submit that, along with your receipt of payment for said service to you insurance company for reimbursement. The Superbill has all of the necessary information (business name and address, tax ID, nation 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.
My insurance carrier is Medicare – Are there any special rules that apply to physical therapy services?
Physical therapy services are generally covered under Medicare Part B, provided the service is considered medically necessary to treat a disease or condition. Under current Medicare regulations, Physical therapists are unable to accept cash pay from Medicare recipients for services that may be covered under Medicare, even if the services provided meet all treatment, documentation, and HIPPA requirements and have been prescribed by their physician.
ELEVATE Therapy Services is not a Medicare Provider, so law prevents us from providing Medicare patients with what would be considered “normally covered services.” If you are a Medicare beneficiary and would still like to request treatment with us, please call us at (248) 266-5721.
ELEVATE Physical Therapy is an Out-of-Network provider. What does this mean?
This means that the therapist has not entered into a contact with individual insurance companies to receive reimbursement based on their contracted rates. There are MANY insurance companies, each with their own contacted rates and regulations and ELEVATE PT’s energy is best spent working with patients. It is important to note that in network provider status is not currently based on education, experience, skills or treatment outcomes, but is often determined by the number of providers in a demographic area.
Do I need any specific paperwork? What is needed for “Out of Network Coverage”? What is needed if I’m “FSA/HSA Eligible"?
Out of Network Coverage: All that is needed is a “Statement for Insurance Reimbursement” which is Provided upon Request. It is best to check with your insurance provider beforehand.
FSA/HSA Eligible: Payments can be made with FSA/HSA card. A “Letter of Medical Necessity” can be Provided upon Request for payments made without using benefit cards in order to seek reimbursement.