- What is physical therapy?
- What is the difference between Co-insurance & Co-pay?
- Will the money I pay upfront at every visit cover all my expenses towards my balance?
- Will I know the exact dollar amount I am being charged prior to treatment?
- Will I be responsible for any services my insurance denies?
- Is there a maximum dollar amount that my insurance plan will cover?
- If there is a maximum dollar amount my insurance will pay for therapy per year and I was treated at another facility before being treated at PPTRS are you aware of this?
- Why did you bill my insurance for something they were not going to pay for?
- I thought my insurance covered everything 100%?
- How much time do I have to pay my portion of the bill off once treatment is completed?
- Why does my statement show I have a credit?
Motor Vehicle Accidents
- I’ve been involved in a motor vehicle accident, now what?
- What does third party insurance or liability mean?
- How does billing affect me?
- Do I have to pay anything on my bill, even though I have an attorney?
- Why is it necessary for me to give out additional insurance information?
- You have my health insurance information why are you asking for my auto insurance?
- You have my auto insurance information and a claim number, why do you need my health insurance information?
- How is it decided what insurance company is billed first?
- Why do I have to file a claim on my own insurance policy? I was not at fault.
- Why can’t the other parties insurance policy be billed?
- Why can’t you bill my attorney?
- Should I retain an attorney and why should I give you this information?
- What is a lien/letter of protection?
- What does litigation mean?
- What does settlement mean?
What is Physical Therapy?
Physical Therapy is a dynamic and diverse profession which helps the patient return to their highest level of functional activities, including the spectrum from daily self care and home activities, work activities, and sports activities.
Physical Therapists assist in the recovery process by:
- Decreasing Pain/Swelling
- Increasing Strength & Flexibility
- Correcting Postural Imbalances
- Providing necessary education to prevent future injury/re-injury
- Assessing need for Adaptive Equipment
A Physical Therapist is trained to evaluate:
- Range of Motion
- Performance Endurance
- Functional Mobility
- Neuromuscular deficiencies
- Walking Biomechanics
- Postural Dysfunction
- Muscular Strength
What is the difference between Co-insurance & Co-pay?
A co-insurance is a percentage determined by your insurance plan that you, the patient, will be responsible for once the insurance has processed your claim. For example:
“Let’s say your coverage is 90/10 which means you are responsible for 10% of the allowed charges. Therefore, if we ask you, the patient, to pay $10.00 at each visit the $10.00 will be applied to your ending balance, which is undetermined until your insurance processes your claims.”
A co-pay is a set dollar amount determined by your insurance plan that is due at each visit. For example:
“If your insurance plan requires you, the patient, to pay a $15.00 co-pay at each visit this will be due at each visit.”
Will the money I pay upfront at every visit cover all my expenses towards my balance?
The money you pay at each visit is a portion going towards your ending balance, and it will not cover all of your expenses. The money you pay at each visit goes towards your ending balance and decreases the total amount you will have to pay in the end. This is a way to decrease the chance of having a financial burden on you and your family after you have completed treatment..
Will I know the exact dollar amount I am being charged prior to treatment?
No, your charges will be determined after your physical therapist or occupational therapist has evaluated you on your first visit. Although, you may contact your Patient Service Advocate at 877-552-2996 to discuss any questions you may have.
Will I be responsible for any services my insurance denies?
Yes, all services provided must be paid in full by either your insurance plan or yourself.
Is there a maximum dollar amount that my insurance plan will cover?
Some insurance plans will have a maximum that they will pay towards your therapy.
If there is a maximum dollar amount my insurance will pay for therapy per year and I was treated at another facility before being treated at PPTRS are you aware of this?
No, we are quoted your benefits only. We are unaware of prior charges through another facility.
Why did you bill my insurance for something they were not going to pay for?
When we verify benefits we are told your plan coverage only. We are unaware of any services that will be denied by your insurance plan.
I thought my insurance covered everything 100%?
There may be services which are non-covered under your plan which can’t be determined until your claims have been processed by your insurance company.
How much time do I have to pay my portion of the bill off once treatment is completed?
You can contact your Patient Service Advocate to discuss available payment options.
Why does my statement show I have a credit?
All monies paid at the time of service are held on your account until your insurance processes your claims.
Motor Vehicle Accidents
I’ve been in a motor vehicle accident. Now what?
Being involved in a motor vehicle accident is traumatic enough.
We are here to help answer all of your questions.
Unfortunately accidents do happen, as a result, our team of litigation and payer specialists have put together this list of common questions to help you through this difficult time. If you have any questions that are not listed, please call us at 866-427-5659. We are here to help.
What does third party insurance or liability mean?
If we are given the information for that Insurance company, we usually mail a Lien to them, and if you give your authorization they will cut us a check upon time of settlement.
How does billing affect me?
We will bill you on a monthly basis to make you aware of the status of your account. Although we render billing service to you as a courtesy, you are still responsible for any outstanding charges.
Do I have to pay anything on my bill, even though I have an attorney?
Due to the Statute of Limitations, which vary from state to state, litigated accounts may take up to 2-3 years to get settled. Therefore we ask you to make minimum monthly payments to keep your account current. Payments are due until the case has settled or the account has been paid in full.
Why is it necessary for me to give out additional insurance information?
We will make all possible attempts to get your account paid in full, and leave you with minimal out-of-pocket expense. It is to your benefit to supply us with all the necessary information to avoid future problems and to quicken the process.
You have my health insurance information why are you asking for my auto insurance?
Since all companies are reimbursed 100% by the at-fault party’s insurance, paperwork may be kept to a minimum through your auto insurance policy, rather than your health insurance.
You have my auto insurance information and a claim number, why do you need my health insurance information?
The reason we ask for additional insurance information is because most insurance companies ask you to obtain a referral or authorization from your doctor prior to rehabilitation services. Insurance companies and doctor offices do not give out retro referrals or authorizations for treatment. Also, medical coverage on your policy has a limited amount of money to pay out and once that is exhausted we can bill your health insurance for the difference.
How is it decided what insurance company is billed first?
It depends on whether you have Medical Pay coverage on your auto insurance, and what your health insurance coverage benefits are. If your health insurance has restrictions, such as calendar year maximums, limitations on the visits, etc., you may choose your auto insurance to be primary so that your health insurance is available for other injuries. Also, most health insurance plans will have you complete multiple subrogation forms, accident details, etc. so it may be easier to use your auto insurance.
Why do I have to file a claim on my own insurance policy? I was not at fault.
If you do not file a claim with your own insurance company we will be unable to bill them. You may have health insurance that we can bill, but usually your attorney will as you to go through all avenues of insurance reimbursement before they will litigate the balance.
Why can’t the other parties insurance policy be billed?
We can bill them, but they will not pay us until the time of settlement. This is the time when we would ask our patient to sign a Lien, which we will forward to the other parties insurance company. Once settlement has been reached, generally the balance is paid in full.
Why can’t you bill my attorney?
Once you have retained an Attorney, you will find that he/she will utilize all Insurance Policies available in order to minimize the patient balance at time of settlement. Actually it is beneficial to you for us not to bill your attorney, because if he/she has to review each date of service you will be billed for the time spent. Our Team of Specialists will stay in contact with your attorney and make sure that he/she is aware of all charges.
Should I retain an attorney and why should I give you this information?
Retaining an attorney is completely up to each individual. Attorneys can often help you maneuver through the legal red tape, but in some cases, the patient can work directly with the insurance company. Once you give us your attorney’s name, we will communicate and follow up at least every 30-90 days with that office. We keep each other updated on the status of your case. Usually the attorney will request Medical Records from us when your case is close to settling and a demand goes out.
What is a lien/letter of protection?
A lien is voluntary and is basically a promise by the patient to protect our interests in the event of a settlement. A letter of protection is a document that we receive from your attorney, stating that he/she will protect our interests at the time of settlement. Your attorney will need your authorization to give us this letter so he/she can pay us out of the settlement proceeds.
What does litigation mean?
When your case goes into litigation, it means that your attorney was not able to settle the case. Now the case will be tried, and the court will decide who will be held liable.
What does settlement mean?
Cases usually don’t settle until you as the patient are done treating and have been released from care by your treating physicians. Settlement is when you and the other party come to an agreement, at that time all your medical bills will be paid and you are relinquishing any right to go back for additional reimbursement.