When physical therapy is provided as a medically necessary health care service it is generally covered by one's health insurance. Upon acquiring your insurance information at your first visit, our staff will verify your out-patient physical therapy benefits on your behalf. However, we strongly urge you to review your policy's coverage and exclusions before initiating care. For our private insurance patients, services at Middleburg Physical Therapy
would be covered under the “out of network provider” provisions of your policy. We do participate with Medicare and we do treat patients covered under Worker's Compensation plans. Please read further for details on these and other insurance coverage situations.
Here are some terms to understand:
this is the amount you must pay toward your bill before your insurance plan begins payment.
some insurance policies require you to pay providers a fixed fee at each office visit. These amounts vary and almost exclusively apply to care rendered at “in network provider” clinics.
many insurance policies will have an amount that you owe which is a percentage of the allowed amount that they will pay for a given service.
We are enrolled with Medicare and accept assignment from Medicare which means we do agree to provide our service for the program's reduced reimbursement. We will bill any Medicare secondary insurance as well. These plans exist to cover your co-insurance and sometimes certain supplies. You are responsible for any remaining amount. If you don't have a secondary insurance, this would be 20% of Medicare's allowed amount.
bill private insurance plans. We do not
contract with insurance companies to reduce our fee in an effort to secure access to their pool of insured customers. Our services are covered under your plan's “out-of-network” benefits. This element of most plans usually provides for coverage with a separate deductible to meet and a slightly higher patient responsibility percentage or co-insurance (e.g. 70% - 30% vs. 80%-20%). Patients are expected to pay an estimated amount of the portion they will owe as treatment progresses. We strive to make insurance claim submission and collections as smooth and simple as possible for you. We will verify your benefits with your carrier and provide you with that information promptly. After an initial examination and discussion with your therapist about the likely length of your episode of care, you will be able to project the cost of your care appropriately.
Workman's Compensation cases are somewhat unique because many of these are seen in clinics which are heavily involved in “managed care” while the insurance carrier is paying full fee. “Managed care clinics” also known as “preferred providers” reduce their fees in exchange for access to an insurer's pool of customers in a specified geography. It is our experience that contracting to reduce fees requires such clinics to use a business model which is dependent on scheduling a high volume of patients per hour in order to be fiscally sound. The result is often that Physical Therapists are not making important decisions about the severity, irritability or nature of a patient's condition because their care is delegated to assisting staff. Therapists will often admit they aren't doing their best work and are feeling over-worked in these situations. For the Worker's compensation case we view this as the injured worker getting less care while the carrier is paying full fee for services. Every adjuster and nurse case manager should be aware of this dichotomy relating to injured workers as it can have a significant impact on speed of recovery and cost-effectiveness.
We do bill auto insurances when you have injuries related to an automobile accident and you have a medical coverage benefit. We do not bill 3rd party auto insurance such as the insurance of the other party in an accident when you are not at fault. In this case we expect payment through your personal health insurance or medical coverage component of your auto policy.
We do not take cases that are in litigation on any type of contingency or lien basis. If you are in need of physical therapy services, you will be treated as a private pay patient, or you may use your private insurance and your attorney will reimburse you from the proceeds of any favorable litigation.