Am I Covered?
Understanding Physical Therapy Insurance Benefits
Having access to the best physical therapy clinic for your treatment is essential. However, we know that many roadblocks exist when it comes to choosing the right physical therapist, including understanding your insurance benefits. At Therapydia, we’ll happily explain your coverage before you begin treatment so that there are no surprises. For those who don’t have insurance or prefer to pay out of pocket, we accept cash payments as well.
Do you take my insurance?
Yes, we accept all insurances. We also accept Workers’ Compensation, Auto Claims, HSA, FSA, and cash-based payments. At Therapydia California, we bill most insurance plans directly and follow standard insurance billing procedures, including applying any deductible, copayment, or coinsurance required by your plan.
Insurance Carriers We Bill Directly
We bill Aetna, Cigna, UnitedHealthcare, Health Net, Meritain Health, and many others directly. Direct billing availability may vary by your specific plan. Contact our team to confirm how we work with your coverage.
Out-of-Network May Be More Affordable Than You Think
Although we are out of network with many insurance carriers, that doesn’t always mean a significantly higher cost. Depending on your plan’s out-of-network benefits, your out-of-pocket cost may be similar to—or closer than you expect to—what you would pay at an in-network clinic.
Know Your Estimated Cost Before You Schedule
Call any of our clinics, and our team can usually check your benefits over the phone and explain your estimated cost per visit before you book your first appointment. If your plan requires payment at the time of service instead of direct billing, we’ll explain those options as well.
Benefit verification and pricing estimates are based on information provided by your insurance company. Final coverage and patient responsibility are determined when claims are processed.
If you’re not in-network with my insurance, can I still receive treatment at Therapydia?
Absolutely! If your insurance provider is out-of-network, that only means that we don’t have a specific, pre-negotiated contract with them. Fortunately, most insurance companies offer out-of-network benefits which very often cover a significant portion of your treatment costs, although the percentage may differ compared to a provider that is in-network. We know that maneuvering through your physical therapy benefits can be confusing, but we’re here to help (seriously, we do this all day). We’re happy to call your insurance company on your behalf to help you figure it out. We’ll also help you submit a claim form to your insurance in order to receive reimbursement.
Why is Therapydia an out-of-network provider?
By choosing to work with us, you’ll receive one-on-one treatments with a physical therapist for the entire duration of your treatment. We are proud to offer a high level of care customized to your goals and needs because we know that quality care delivered in a thoughtful manner will help you get better, faster. While other in-network clinics may utilize a “shared treatment” approach—seeing multiple patients at once, passing off patients to aides or assistants, etc.—Therapydia embodies a different philosophy of care. We believe that individual attention with a physical therapist is the fastest route to an efficient recovery.
Am I responsible for a copay at the time of visit?
Coverage under each plan varies significantly but we can contact your insurance provider prior to your first visit to see what your benefits include. It’s possible that you’ll be responsible for a copay—a set amount each visit that you pay in addition to what your insurance pays—or a coinsurance amount. Either way, we’ll let you know.
What is coinsurance?
Depending on your coverage, coinsurance is your share of the costs of a health care service. It’s a percentage that kicks in after you’ve reached your plan’s deductible. Ex: Your insurance might pay 80% and you would be responsible for 20%.
What is a deductible?
An insurance deductible is the amount of money set by your insurance provider will start covering your services. For example: If your deductible is $500, you have to spend $500 of your own dollars before they cover any of your expenses. Until you meet that deductible, you’re responsible for the full price of your visit.
If you have any insurance questions or concerns, feel free to give us a call to ask! We are happy to help you understand your coverage before you begin treatment so that there are no surprises. We don’t want you to worry about anything besides beginning your path to lifetime wellness!