Rates and Insurance

SPINE PT is an out-of-network provider, also referred to as a fee-for-service clinic that is not in-network with any insurances. Upon request, receipts can be provided that include the necessary codes to send self claims to your insurance company. SPINE PT has made it easy to submit claims to your insurance company in less than 2 minutes through an app called Reimbursify.

Why doesn’t SPINE PT bill insurance, and could this
save you money?

When insurance is billed, clinics are limited in what they can do for patients if they want to be reimbursed for services. This has forced some in-network physical therapists to provide care that is optimal for reimbursement but not the best for patients. Even with clinics trying to get optimal reimbursement from insurance companies, they still struggle to keep their doors open. They look for ways to reduce their expenses and will often hire high school students to help provide some aspects of care while the therapist works with other patients. Therapists are expected to see 2-4 patients an hour, which is difficult to do. Since therapists cannot directly work the entire time with any of their patients, they need to use “filler activities,” like riding a stationary bike or using modalities (hot packs, ultrasound or electrical stimulation), that will occupy your time while they work with someone else. These filler treatments do no speed up the healing process and are a waste of patient’s time.

I tried to use insurance in 2001 when I opened my first clinic in Ohio but quickly discovered all the challenges of dealing with them. I decided to be an out-of network provider because I refuse to play games when it comes to getting my patients better. I know firsthand how stressful it is to have back and neck issues and am committed to doing everything my patients need to heal.

Health insurance plans have changed over the years with higher copays and deductibles. In many instances, these cost increases have made it cheaper to not use your in-network insurance for PT services.

Insurance companies are shifting the upfront expenses for patients by increasing deductibles and copays. This means you could be paying the full cost of treatments, even at a clinic that takes your insurance. These clinics are designed to charge the maximums allowed, which in many instances will cost you more than being treated at SPINE PT.

To help you determine your actual cost of care at an in-network facility, here are some questions you can ask your insurance provider.

1. How much is your deductible for an in-network provider?
2. Is there a separate deductible for in-network vs out-of-network?
3. If you have already met your in-network deductible, how much will your co-pays
be each visit at an in-network provider?
4. What percent of the total physical therapy services would you be responsible for?

Questions to ask a potential in-network PT clinic.

1.  What is their average cost per visit?
2. How long are their treatments (i.e. time in their office)?
3. How many times a week do patients come in for PT and how many total visits they generally see people for with symptoms like yours?
4.  What are typical treatments like?
5. What percentage of the patients they see are spine related? You will want to make sure you aren’t being treated by a therapist who primarily sees lots of total hip and knee patients.

Most typical outpatient therapy clinics will see people for 3x/week for 4 – 6 weeks for a total of 12-18 visits. Spine PT generally sees people for 6 visits, spread out over 4 weeks. Needing to come in for less therapy at SPINE PT means you won’t be paying for all the extra visits at another facility. It also means less time away from work, your family, and your hobbies. The one-on-one manual therapy visits speed up the healing process by directly targeting the affected  issues and structures to get you back to what you love.

When you take a closer look at what you are actually getting at SPINE PT, I think you will find the overall costs will be less and at the same time have the benefit of working one- on-one with a physical therapist that only treats the spine.

Getting reimbursed by your insurance for your out-of- network benefits using Reimbursify.

Getting reimbursed will largely depend on the insurance you have and what benefits are included in your unique policy. Reimbursify is an app that can help you successfull submit claims for reimbursement to your insurance. You can download it onto your phone and easily submit your receipts to your insurance company within 2 minutes.

Can this app be used with all insurances?

Most all insurance except Medicare can receive claims using Reimbursify. Upon request, Spine PT will give an invoice for care with proof of payment. The invoice instructs the insurance provider that the bill has already been paid and to send any payments to the patient.

The amount of reimbursement or application towards your deductible is completely dependent on your insurance plan. If you call your insurance company to inquire about what you can expect to receive, you should ask about reimbursement for “out-of- network Physical Therapy” expenses sent in via self claims.

Important Note For Medicare Beneficiaries:

The US government has some interesting laws that control where Medicare beneficiaries can spend their healthcare dollar and persuade healthcare providers to enroll in their system. Because SPINE PT is not a Participating Medicare Provider, SPINE PT can only accept Medicare beneficiaries as patients when the patient does not want Medicare billed for any PT services. This request to not involve Medicare in payment must be made up front by the patient and be made of the patient’s own free will.

In other words, if you’re a Medicare beneficiary and are adamant about seeing SPINE PT for your care, even though SPINE PT is not a participating Medicare provider, we can help … However, the only way we can provide you with PT services is when you truly don’t want Medicare involved and you ask up front that Medicare not be billed or involved in your physical therapy care.

If you DO WANT to use your Medicare benefits for physical therapy, we cannot provide you with treatment at SPINE PT, but we can help you find a good Medicare provider in your area.