Insurance

Insurance

Cornerstone Physical Therapy participates with many health insurance plans, HMO’s, PPO’s and Worker’s Compensation networks. For the most current list of our insurance contracts please contact our office. As a courtesy to you, we will verify your insurance benefits before you come in so that you know what your physical therapy sessions will cost.

Disclaimer: Your insurance reserves the right to alter your benefits at any point in time and benefits are determined at the time the claim is received.

  • Deductible: Amount set by your insurance company that you must pay before they pick up any part of the cost.
  • Co-insurance: The amount you are required to pay after meeting your deductible. It is a set percentage of the charges and your insurance company pays the other percentage.
  • Co-payment: Amount set by your insurance company that you pay each visit and they cover the remaining amount of the charges for the visit.
  • Prior-Authorization: Certain insurance companies require that we submit for authorization for visits. Typically, they give us a date limit and/or a certain number of visits allowed. If more visits are needed beyond this time limit or visit limit, we can ask for more.
  • Out of Pocket Maximum (OOPM): Amount set by your insurance company for the amount of money you have to pay out of pocket in any given policy/calendar year. There are both in- and out- of network OOPMs. Some plans include the deductible and co-payments in the OOPM, others do not.
  • Visit Limitations: Some insurance companies put limitations on the number of visits they will allow each policy/calendar year. If visits are based on Medical Necessity, it means that if your therapist and doctor agree that services are medically necessary then the insurance company will most likely cover the service.
  • Policy Year vs Calendar Year: Policy Year: 12-month timeframe that runs differently than the calendar (ex. July-June). This means that your deductible does not start over at the beginning of the year, it means that it will start over when your policy year starts over. Calendar Year: runs the traditional calendar year (January – December)
  • Referral Requirements: Some insurance policies do not require a referral from a physician, while others absolutely do require a referral.Ex: Medicare requires a referral from a physician (cannot be a dentist, chiropractor, etc.)
  • Hospital vs. Professional/Office: Benefits vary for locations based on the setting of the physical therapy clinic.
  • Assignment of Benefits: Our best estimation of your insurance benefits based on what your insurance company has told us.

If you have any questions about your insurance policy and what it covers, please contact Adrienne, our billing manager, or Alisha, our billing assistant, and either one of them would be happy to help you.

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