Most insurance plans, including Medicare, workers’ compensation and private insurers pay for physical therapy services that are medically necessary and that are provided by or under the direction and supervision of a physical therapist.
Ascend Physical Therapy & Wellness is a preferred provider with many managed care networks and we accept most major insurance plans. We also accept Medicare and Workers Compensation and participate with many local provider networks. To ensure that your insurance provider is on our list of accepted plans, we invite you to call 703-272-8801 in advance of your appointment to check. We will make every effort to verify your eligibility prior to the start of treatment.
The fact that your insurance plan covers physical therapy services—or any other services, for that matter—doesn’t necessarily mean you won’t have any out of pocket payments. In many cases, you’ll still have to pay a deductible, a co-insurance, or a copayment.
To better understand the terms of your plan, you first must understand the terminology. Here are a few common questions regarding insurance lingo:
What is a deductible?
This is the total amount you must pay out-of-pocket before your insurance starts to pay. For example, if your deductible is $1,000, then your insurance won’t pay anything until you have paid $1,000 for services subject to the deductible (keep in mind that the deductible may not apply to every service you pay for). Furthermore, even after you’ve met your deductible, you may still owe a copay or co-insurance for each visit.
What is a copay?
This is a fixed amount that you must pay for a covered service, as defined by your health plan. Copays usually vary for different plans and types of services. Typically, you must pay this amount at the time of service. Again, copay amounts are fixed—which means you will always pay the same amount, regardless of visit length. In most cases, copayments go toward your deductible.
What is a coinsurance?
This type of out-of-pocket payment is calculated as a percent of the total allowed amount for a particular service. In other words, it’s your share of the total cost. For example, let’s say:
- Your insurance plan’s allowed amount for an office visit is $100.
- You’ve already met your deductible.
- You’re responsible for a 20% coinsurance.
In this situation, you’d pay $20 at the point of service. The insurance company would then pay the rest of the allowed amount for that visit. Keep in mind that the coinsurance amount may vary from visit to visit depending on what services you receive.
Most insurance companies, with the exception of Medicare and many HMOs, permit members to go “out of network” for health care services. This means you can choose to see a physical therapist who is not a participating provider with your insurance company. Many patients choose to receive services out of network in order to see the physical therapist of their choice and our clinic treats many patients with out of network benefits. In most cases, the amount paid by the insurance company will be less, and you will be responsible for paying the difference between what your physical therapist charges and what the insurance company will pay.
Should insurance coverage not be available or is not paid at the level a patient is told by their insurance company, the patient will ultimately be responsible for their bills.
Individualized options are available for patients without insurance coverage or for those who decide not to bill their insurance provider.
Co-pays are due at the time of service.
Ascend Physical Therapy & Wellness is conveniently located at 307 Maple Ave W, Suite D, Vienna, VA 22180 and accepts cash, checks, MasterCard, Visa, American Express and Discover.