top of page
Search
  • Writer's pictureGreg Schumann

FAQ - Cash Based Physical Therapy

WHY CASH BASED FOR PTinPHILLY?

The answer is simple. It allows us the ability to provide high quality 1:1 care. Thanks to transparent pricing, reduction of unnecessary paperwork, and being able to offer services without insurance permission, we’re able to focus on what matters, your care. We pride ourselves on high-quality manual therapy skills and corrective exercises and we don’t have to worry about being approved for our services. It will also save you money. Our flat rate for an evaluation and subsequent treatments can be significantly cheaper than the average insurance based evaluation and treatment. With typical Insurance based evaluations ranging from $250-$400 and treatments $150-$300 costs can add up quickly.

WHAT DOES CASH-BASED PHYSICAL THERAPY MEAN?

In a cash-based treatment model, the patients pay us directly for their 1-on-1, personalized physical therapy services after both parties have determined a plan that will help them reach treatment goals most efficiently. This allows us to focus all of our attention on the patient and perform treatments to focus on patient goals without being dictated by

HOW DOES CASH-BASED PHYSICAL THERAPY WORK?

If you haven’t met your deductible or have a high co-pay, this is the spot for you. If you have not met your deductible, you are essentially a cash paying customer anyways. When it comes down to dollar-per-minute, cash based therapy becomes cheaper due to less treatment sessions and lower cost because it is not inflated for hopes of partial reimbursement dictated by insurance companies


DOES CASH-BASED MEAN I CAN ONLY PAY WITH CASH?

Even though this model is called cash-based you are not limited to cash payments, You may pay for services with cash, credit, debit, check, Flexible Spending Accounts (FSA), Health Savings Accounts (HSA) and Health Reimbursement Accounts (HRA). By not being in network with insurance companies we are able to keep our Cash rates affordable and significantly below the cost of negotiated insurance rates.

PTinPHILLY IS AN OUT OF NETWORK PROVIDER - WHAT DOES THIS MEAN?

This simply means that the therapist has not entered into a contract with individual insurance companies to receive reimbursement based on their contracted rates. That doesn’t mean you can’t receive reimbursement for your costs incurred seeing us. With the help of our Admin and staff, we can guide you through the process of submitting your Superbills as claims to your insurance company for reimbursement. We can not guarantee any reimbursement percentage as it is based off of your Individual insurance and their Out of Network policy. 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.


CAN MY INSURANCE BE BILLED FOR CASH-BASED PHYSICAL THERAPY SERVICES?


Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, 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 to receive services out of network in order to see the physical therapist of their choice. The end goal of documentation and billing is the same - getting paid - it's just that, in the case of cash-based services, it is the patient who is waiting for reimbursement rather than the provider.


DO I NEED A PRESCRIPTION FROM A DOCTOR FOR PHYSICAL THERAPY?

No you do not! In Pennsylvania we are a Direct Access state, meaning that you can begin Physical Therapy without a Physician Referral. If we notice any Red Flags during your evaluation we will refer out to an appropriate medical provider at that time. If you are looking to be reimbursed for the cost of your Physical Therapy, it definitely strengthens your ability to receive a maximum reimbursement percentage by your insurance company.

WHAT HAPPENS WHEN PAIN IS NO LONGER AN ISSUE?

That is when the fun begins. Our goal is to set you up for long term success. We have a team of licensed Doctor of Physical Therapy and certified Personal Trainers so we will work with you to determine what the next steps for you should be. We can set you up on a fitness and wellness program under the supervision of our Physical Therapist who treated you originally.

WILL I END UP PAYING MORE FOR CASH-BASED PHYSICAL THERAPY?

In many cases, the out of pocket expenses for a course of physical therapy will actually be LESS for services provided at PTinPhilly. In large part, this is due to the ability to charge less per visit, with these charges being well 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 allows our staff to focus all energy on patient care, and allows patients to make informed decisions regarding the costs of their health care choices.


WHAT STEPS ARE INVOLVED IN SUBMITTING A CLAIM TO MY INSURANCE COMPANY?

The process is actually quite simple: PTinPhilly will provide you with an invoice at the time of service, and you may submit that invoice, along with your receipt of payment for said service to your insurance company for reimbursement. The invoice has all of 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.


BUT WHAT IF I MET MY DEDUCTIBLE OR HAVE A LOW CO-PAY?

If your deductible is met or has a low co-pay then you can still submit for reimbursement through your insurance. Getting reimbursed for an out-of-network provider typically merits a 40-80% reimbursement rate. For the best chances to get reimbursed, having a doctor's order is not required but may help with the reimbursement process

HOW DO I MAKE AN APPOINTMENT?

Please visit our booking page here to submit a date and time you’d be interested in scheduling an appointment. We ask that you provide a little information on what you’re interested in so we can best prepare ourselves for your appointment. We’ll get back to you as soon as possible to book your appointment!


62 views0 comments

Comments


bottom of page