Billing

In many cases, health insurance will cover most of your treatment. It largely depends on your insurance coverage, if the clinic is in-network or out-of-network with your insurance plan. However, make sure you talk to the clinic’s billing department so they can help you clarify your insurance coverage and you understand your financial responsibility for your treatment. Some clinics will have a same day payment discount or cash pay rate. Be sure to ask as this could possibly save you on your health investment.

Billing for therapy services is similar to what happens at your doctor's office. When you are seen for treatment, the following occurs:

1. At the time of your visit you will likely be asked to pay your copay or for the cost of the visit.
2. The clinic bills your insurance company, Workers' Comp, or charges you based on Common Procedure Terminology (CPT) codes.
3. Those codes are transferred to a billing form that is either mailed or electronically communicated to the payer.
4. The payer processes this information and makes payments according to an agreed upon fee schedule.
5. 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.
6. 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.

At any time along the way, information may be missing, miscommunicated, 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 and send you a bill for the balance as long as six months after the treatment date.

What is a Superbill?

Some out-of-network clinics may provide you with a superbill which contains all the codes and information you need to file a self-claim with your insurance company. You submit this directly to your insurance company for reimbursement. This process is an option some clinics use because it is more streamlined for both the clinic and the patient.