Insurance & Billing
Insurance & Billing
Thank you for selecting Peak Performance as your physical therapy and sports rehabilitation provider! It is our mission to get you back to peak performance as quickly and safely as possible. We appreciate that the cost of medical services can be difficult to understand, and it is our goal to make the billing process as easy and transparent as possible.
Medicare
HAP
Blue Cross Blue Shield
Workers Comp
Auto Insurance
Self Payment
We have added some new payment features to assist in the process, and provided some resources regarding the Billing Process, please check them out below.
For further billing inquiries, please email or call us.
Verification and Submission
When you call to schedule your first appointment, we’ll ask you for your insurance information. Then, as a courtesy to you, we will call your insurance company to verify your benefit coverage and we’ll review this information with you before you begin your first visit.
In addition, we encourage you to call your insurance carrier to find out your physical therapy and/or occupational therapy benefits provided by your medical plan prior to your visit.
Finally, we will promptly file your claim with your insurance company on your behalf so you won’t have to worry about having to fill out any other forms.
Billing for physical therapy services is similar to what happens at your doctor’s office. When you are seen for treatment, the following occurs:
– The physical therapist bills your insurance company, Workers’ Comp, or charges you based on Common Procedure Terminology (CPT) codes.
– Those codes are transferred to a billing form that is either mailed or electronically communicated to the payer.
– The payer processes this information and makes payments according to an agreed upon fee schedule.
– An Explanation of Benefits (EOB) is generated and sent to the patient and the physical therapy clinic with a check for payment and a balance due by the patient.
– The patient is expected to make the payment on the balance if any.
– It is important to understand that there are many small steps (beyond the outline provided above) within the process. Exceptions are common to the above example as well. At any time along the way, information may be missing, mis-communicated, or misunderstood. This can delay the payment process. While it is common for the payment process to be completed in 60 days or less, it is not uncommon for the physical therapy clinic to receive payment as long as six months after the treatment date.
Outstanding Accounts
Accounts are continuously reviewed. Patient accounts with balances greater than 90 days with no outstanding/open insurance balance are subject to being sent to a third-party collections agency. Courtesy calls/emails will proceed any information sent to collections.
Insurance Terminology
Premium: A monthly payment you make to have health insurance. Like a gym membership, you pay the premium each month even if you don’t use it, or you lose coverage. If you’re fortunate enough to have employer-provided insurance, the company picks up all or part of the premium.
Copay: Your copay is a predetermined rate you pay for health care services at the time of care. For example, you may have a $25 copay every time you see your primary care physician, a $10 copay for each monthly medication and a $250 copay for an emergency room visit.
Deductible: The deductible is how much you pay before your health insurance starts to cover a larger portion of your bills. In general, if you have a $1,000 deductible, you must pay $1,000 for your own care out-of-pocket before your insurer starts covering a higher portion of costs. The deductible resets yearly.
Coinsurance: Coinsurance is a percentage of a medical charge that you pay, with the rest paid by your health insurance plan, after your deductible has been met. For example, if you have a 20% coinsurance, you pay 20% of each medical bill, and your health insurance will cover 80%.
Out-of-pocket maximum: The most you could have to pay in one year, out of pocket, for your health care before your insurance covers 100% of the bill.
Expectations for Patient Costs
We will file insurance claims on your behalf. We also offer self-pay (cash) rates. For plans with a deductible, we will typically collect $50 to apply toward your overall balance (deductible). This is not a single payment for that particular visit but is applied to your overall plan of care. These payments help alleviate a large bill at the end of your service.
Stress-Free with Automatic Billing
For your convenience, we have set up an autopay process at each location. Your credit card will securely be stored in our system and ran at each visit, and upon receiving each EOB (Explanation of Benefits). No PAPER bills will be mailed. Receipts will be emailed following the charge of the credit card on file and itemized receipts available upon request.
- Please note: it can take 6-8 weeks for claims to process.