rates and insurance
Medicare Part B
I am a participating provider with Medicare Part B.
Out of network provider
I am an out-of-network provider with many private insurance carriers.
Because I would not be able to provide the level of care and individualized treatment required for rapid patient recovery at the rates insurance companies pay for physical therapy treatment.
During each insurance visit, the time you spend with a therapist is typically 15 minutes or less, due to the need for the therapist to see 4 patients per hour. Companies need their therapists to do this because insurance reimbursements are getting less and less so the therapist is made to see more patients to make up for the smaller reimbursements. After 15 minutes, the patient is turned over to an aide to complete the exercises, stretches, and passive treatments.
I believe 15 minutes is not enough time to re-evaluate the patient from the previous visit, see if the home exercise program is appropriate, make changes, and perform the current treatment. The end result is the patient may have to be seen more times and therapy takes longer to complete.
My goal is to get the best possible outcome for my patient in fewer visits. To accomplish this, I spend the entire hour with you, using techniques and methods appropriate for your needs. Because the treatment is focused entirely on you, the result of each visit helps you heal faster.
This could actually result in the same or less out of pocket spend for the patient with a much higher quality of care because each session provides more benefit to you and healing can be faster.
The rate for treatment is $125 per 60 minute session. Because the sessions are concentrated on only you, each session is similar to a week of treatment (4 15-minute sessions). This makes it so that in many cases, only 1-2 visits per week is required. With this, you also get access to me via phone and email to answer any of your questions, and my guarantee to respond to you in a timely manner.
I said above that it could actually cost the same or less out of pocket. Here is how:
Under insurance-based physical therapy, lets say you have a copay of $30 per visit. Your treatment plan calls for 3 visits per week (45 minutes of treatment) for 8 weeks = $30 * 3 * 8 = $720 out of pocket.
The total treatment time with the therapist is 360 minutes over 8 weeks.
Under cash-pay physical therapy, there is no copay, just the cost per visit. The same treatment plan calls for 1 visit per week (60 minutes of treatment) for 4 weeks = $125 * 4 = $500 out of pocket.
The total treatment time with the therapist is 240 minutes over 4 weeks.
The key is the personal attention that you get and hands-on time with the therapist.
Side by side comparison:
18-24 visits at $30/visit = $540-$720 over 6-8 weeks
3-4 visits at $125/visit = $375-$500 over 3-4 weeks
If you have insurance, I will provide everything necessary for you to place an "Out-Of-Network" claim to your insurance company. This includes receipts for payment and treatment codes. Most insurance coverage has provisions for Out-Of-Network benefits.
For most insurance companies, you can find a claim form on their website. Simply print it out and submit it along with your receipts and treatment codes that I provide for you. The amount you are reimbursed is dependent on your “Out-Of-Network Physical Therapy” expense benefits.