We are glad you are considering us to serve you and we want to help you understand what to expect in the way of fees and payment for treatment. Today, many patients have high deductibles and must therefore pay most, if not all, of the expense of their treatment. If you have insurance coverage from an insurer and under a plan in which we participate, we will help you as best we can to understand your coverage, co-pay, co-insurance and unmet deductible amount. If your deductible has not been met, the amount your insurer allows for treatment under a plan in which we are an in network provider will be due upon arrival for your appointment. This will vary by plan. If your deductible has been met, you will only be responsible for the co-payment or co-insurance.
If you are insured by a plan in which we do not participate or are out of network, but the plan nevertheless provides some payment for out of network providers, you will be responsible for the fees upon arrival for your appointment. We will bill your insurer as a courtesy. Usually the reimbursement goes directly to the patient, but if it comes to us, we will promptly forward the funds to you. If your insurer normally pays directly to the provider and we can determine what we will be paid, we will only collect the balance over the expected reimbursement at time of service.
We are a specialty clinic with highly trained therapists and the diagnoses we treat require much more time than many post operative treatments and treatments for many injuries. Because some insurers now allow a reimbursement below our direct cost of treatment (let alone a contribution to overhead) we can no longer be in net work or a participating provider. If you are covered by Coventry or Anthem Healthkeepers, you will be responsible for treatment fees at time of service. We will provide you with a receipt which you can attach to a claim if the insurer pays any reimbursement for out of network providers. Currently, Coventry HMOs do not and only some Anthem Healthkeepers plans pay out of network providers.
Finally, your plan might require pre-authorization to reimburse us or you for visits and it might limit the number of visits and total amount of reimbursement. We will help you with pre-authorization under plans for which we are in network or participating providers. Otherwise, you need to inquire about authorization and failure to do so might prevent your reimbursement. Under Virginia law, you can come directly to a physical therapist without a doctor’s prescription. Be aware, however, that many insurance companies will not reimburse unless you first see a physician and obtain a prescription for treatment.
Please ask for our “Insurance Worksheet”. By calling the members’ number on your insurance card, or visiting the insurer’s web site, you can get answers to the questions in the worksheet that will help you more accurately calculate your out of pocket cost of service.
Our "Self Pay" fees:
Initial evaluation: $200
Treatment: $100 per visit