Uhan Performance Physiotherapy is a pay-at-time-of-service, out-of-network physical therapy provider. Client reimbursement is based on the out-of-network benefit of the individual insurance plan.
Physical therapy clinics will negotiate with each insurance company for inclusion into each network. This often occurs when the clinic offers steep discounts to the provider (as well as agreeing to a myriad of stipulations and limitations of service). In exchange, the percent cost-to-client is smaller — after any deductible is met.
For a primer on insurance coverage and how deductibles work, click here.
When a clinic does not negotiate with insurers, the insurer deems them out-of-network. The overall percentage cost is higher for the client (usually by 10-40%).
However, out-of-network providers are not bound by any stipulation or limitation of the insurers many of which limit the quality and length of treatment visits. For a more detailed cost and value comparison between cash-based and in-network practitioners, click here.
Uhan Performance Physiotherapy clients must pay in full for each session at the date and time of service. Various payment methods are accepted, including cash, check and credit card (both in-person and online).
Uhan Performance Physiotherapy provides each client with a Superbill, which is a receipt of service, outlining:
Treatment for a for a specific diagnosis
Detailed treatment charges and descriptors (called CPT codes)
Date of service
Detailed information on Uhan Performance Physiotherapy as a provider
This Superbill can then be submitted to the insurer, by clients eligible for reimbursement. Clients are then reimbursed directly by the insurance company for their cost.
Uhan Performance Physiotherapy will also produce and provide any necessary treatment document (evaluation, progress reports or other letters of medical necessity) to the client.
However, because of the increasingly high cost of deductible, most Uhan Performance Physiotherapy clients choose to simply pay out of pocket, rather than apply the fee to their deductible.
For information about billing your insurance, click here.
Health Savings and Reimbursement Accounts
Because Uhan Performance Physiotherapy is a licensed, registered medical facility, clients may use HSA or HRA accounts — using either their HSA debit card or reimbursing to their employer or insurer.
Be an informed healthcare consumer, contact your insurer
It is the responsibility of the client to verify benefits and determine if and how they are eligible for physical therapy benefits. While the State of Oregon is a Direct Access state, some insurers require a physician referral in order to pay for physical therapy. Other insurers may require other forms and authorization.
In exchange for longer treatment time and less paperwork, Uhan Performance Physiotherapy has no direct interaction with health insurance companies. They cannot verify coverage or cost per client, complete any prior or subsequent authorizations, or obtain reimbursement or payment from the insurer, for the client.
Only Superbill receipts and treatment document will be provided to clients.
A Primer on Physical Therapy Insurance Benefits
In most health insurance plans, physical therapy is considered a “speciality care service”. For primary care practitioners, insurance requires the client pay only a flat-rate copay per visit (usally $10 to $50). Physical therapy is billed with treatment units based on time spent (usually 15-minute blocks) for various activities (including manual therapy and exercise). Insurance companies then pay a percentage of the bill, with the patient responsible for the rest.
However, nearly all plans require that a deductible be first must be paid by the client before the insurer pays for anything. These deductibles range from $0 to 100 for the most lucrative plans, while the median plan typically has between $1000 to 3000 per individual, or $2000 to 6000 for a family.
Deductibles, designed as a deterrent against overutilization by the client, are substantial and increasing as healthcare costs continue to rise.
Physical Therapy Cost Breakdown
In Lane County, Oregon, the average hourly fee billed to an insurer for PT treatment is $250 to 300. An in-network discount to the insurer is often as much as $100. The remaining $150 to 200 is split between the insurer and client.
Insurance providers then pay between 60-100% of the remaining charge, along any number of other fees:
Co-pay. This is a flat fee, paid with each visit, regardless of duration or treatment type.
Co-insurance. This is a percentage of the after-discount charge, usually 10-50%
What this means for the client: clients with deductibles must pay 100% of all fees, out-of-pocket, until the deductible is met, before any actual insurance benefit kicks in.
PT Deductible Scenario
Let’s say you attend a standard physical therapy visit in Lane County Oregon, to an in-network provider. The visit lasts one hour. Subsequent visits are thirty minutes (and billed as half that price). The client has a $1500 deductible.
Clinic base rate fee: $260
Innetwork discount to insurer: -$100
Net cost of initial evaluation to client, billed to insurer: $160, applied to the deductible
Total number of physical therapy visits that a client must pay 100% out-of-pocket before partial benefits are received: 18. (1x evaluation @ $160 + 17x follow-up visits @ $80)
This means the client with a $1500 deductible may have to attend up to 18 visits — and pay for each visit, 100% out-of-pocket — before receiving any insurance payment on his or her behalf!
The increasing size of insurance deductible is a driving force behind a higher-quality, pay-at-time-of-service clinical practice. Utilizing hour-long visits at a more modest rate, Uhan Performance Physiotherapy clients obtain more value and multidimensional collaborative care — with significantly less cost.