Private Physical Therapy Insurance Questions

Fitness & Function exclusively provides In-Home OutPatient Physical Therapy; we focus on people—not just illnesses and conditions. Our unique, personalized approach to health care means that we’re partners in your quest for long-term health by bringing the clinic to you. Private Physical Therapy is provided as a 'Fee for Service', payment is required in full at the time of service. Depending on your out-of-network physical therapy benefits, you may be eligible for reimbursement. 
 

Patient is responsible for finding out their Out-of-Network benefits with their insurance.

 

Your Physical Therapist provide you with a receipt(claim form) for services with the necessary treatment billing codes. It is the patient's responsible for submitting this claim form to their insurance. We recommend patients make a copy of this claim form for their own reference prior to submitting claim to insurance.

Medicare B

Fitness & Function LLC is an APPROVED MEDICARE B NONPARTICIPATING PROVIDER. Our PT Bayla accepts Medicare B patients as a NONPARTICIPATING PROVIDER. Payment is required in full at the time of service. Fitness & Function will send the claim to Medicare for reimbursement to the client.  

There maybe services that Medicare does not cover, in which case you receive an Advanced Beneficiary Notice (ABN) to sign. The client/patient receives reimbursement from Medicare for approved services. Reimbursement varies depending on the insurance coverage and your specific supplemental commercial insurance plan. Please take the time to fully know and understand your plans for out of network outpatient physical therapy benefits.

 

Please note: Not all physical therapists with Fitness & Function choose to work with the restrictive rules, regulations and complicated requirements of Medicare B.

Is Private Pay Physical Therapy the Best for You to Reach Your Wellness and Health Goals?

Question: Why should I hire a Private Physical Therapist?
Answer: You see the value of your treatment being a full hour, one-on-one with a licensed physical therapist. As a cost containment method, many conventional clinics PT appointment are 30 to 45 minutes and an assistant or aid provide most of the hands-on care after the actual evaluation. Fitness & Function clients receive their care for evaluations and all sessions by a highly qualified PT that provides customized programming. Fitness & Function physical therapists are truly the cream of the crop. Our therapists are invested in their profession and its success and therefore, as your therapist invested in YOU, your progress and ultimately customer satisfaction.

 

Question: What does private pay fee for service or cash pay mean?
Answer: This means that patient pays the therapist the fee for service at the time of service. No more run of the mill, on the clock therapists who stick around for 10-15 minutes giving you canned programs that do not progress you towards your goals. Your therapist comes to your home and sees you, then you pay your therapist. We find that the restrictions placed on physical therapy services by third-party payers interferes with the ability to help clients reach their goals. Private physical therapists can provide you with the exceptional care that you are looking for

Question: Will you bill my insurance?
Answer: We do not submit bills to your insurance. Our physical Therapist are committed to providing exceptional, quality care to you. Fitness & Function's Physical Therapy services are a designated 'out of network' provider for clients who have commercial insurance plans with benefit coverage for outpatient physical therapy. Most insurance plans coverage for out of network is approximately 60% to 80% of charges. It is the client's responsibility to know their insurance plan and coverage. If your insurance covers out of network outpatient physical therapy services we can provide you with a receipt which you can submit to your insurance company. This receipt contains all the necessary billing codes and information for processing and reimbursement. 

Question: Do I need a doctor's order?
Answer: Most insurance's will not reimburse without a doctor’s order. Insurance reimbursement and the requirement of a physician’s referral, however, is plan-specific. Most insurances do not require a referral, but some do. If you do not have a physician’s referral for physical therapy and are uncertain if one is required in order for insurance to pay, we recommend that you contact your insurance company directly to verify this. If you ask your doctor for physical therapy, insist that he/she give you a script. Many doctors are vested in their own physical therapy clinics or want to send you where they want to send you but it is your choice. Walk out with a prescription in hand that says, 'Eval and Treat', has your diagnosis, your doctor's signature and the date on it. 

Oregon State law provides Direct Access to licensed physical therapists without a physician’s referral or prescription. This means that you can seek medical treatment for your musculoskeletal issues directly from the physical therapist of your choosing. This places private pay physical therapy as a first line provider for your musculoskeletal health.

Question: Are my visits limited if I'm paying cash?
Answer: Yes and no. If your in-home physical therapy is not covered by Medicare i.e. a maintenance program or wellness program, you can pay for as many visits as you want, and can choose to have longer therapy sessions beyond the standard 60 minutes. If, however, your doctor orders a specific frequency and duration, your physical therapist may need to contact your doctor to request the authorization for additional visits.

Question: What is your appointment cancellation policy?
Answer: If you should need to cancel an appointment, please be aware of our requirement of providing at least 24-hour notice. Failure to cancel your appointment with less than a 24-hour notice will result in a $25 fee. Insurance will not pay for this fee, so you will be responsible to pay at your next visit.

Question: Are all Physical Therapy sessions performed by the physical therapist? 
Answer: YES, evaluation and treatment sessions are 60 minutes exclusively with your Licensed Physical Therapist; clients do not receive services from a PT aide or PT assistant. Clients can however receive personal training sessions while under the care of a physical therapist which is billed as personal training.