Patients
Schedule An Appointment
Insurance Coverage
Below is a sample list of insurances Apex Physical Therapy accepts
Simplified General Benefits
Authorizations
Benefits
CO-PAY
CO-PAYS ARE DUE AT THE TIME OF SERVICE (EACH PHYSICAL THERAPY APPOINTMENT)
CO-INSURANCE
CO-INSURANCE IS A FIXED PERCENTAGE THE INSURANCE WILL PAY AFTER YOUR DEDUCTIBLE IS MET
DEDUCTIBLE
DEDUCTIBLE IS THE AMOUNT OF MONEY YOU PAY OUT OF POCKET FOR HEALTHCARE SERVICES COVERED UNDER YOUR INSURANCE PLAN BEFORE YOUR PLAN BEGINS TO PAY BENEFITS FOR ELIGIBLE EXPENSES
OUT OF POCKET
OUT-OF-POCKET EXPENSES REFER TO THE PORTION OF THE BILL THAT THE INSURANCE COMPANY DOESN’T COVER AND THAT THE INDIVIDUAL MUST PAY ON THEIR OWN. WHEN YOUR OUT OF POCKET IS MET, THE INSURANCE WILL PAY A FIXED PERCENTAGE, WHICH IS NORMALLY 100%.
Visits
COMMERCIAL INSURANCE VISITS (BCBS, UHC, AETNA ET CETERA)
BASED ON MEDICAL NECESSITY OR A VISIT CAP
MEDICAL NECESSITY-
THE INSURANCE COMPANY BASES VISITS ON WHAT THEY BELIEVE TO BE MEDICALLY NECESSARY, ALSO KNOWN AS COVERAGE DETERMINATION POLICY. TO HELP THEM DETERMINE THE VISITS THEY WILL USE THE FOLLOWING INFORMATION:
FREQUENCY AND DURATION OF VISITS DETERMINED BY THE PHYSICIAN & THE EVALUATION OF YOUR VISIT BY THE PHSYCIAL THERAPIST.
VISIT CAP-
THE INSURANCE COMPANY ALLOWS A CERTAIN AMOUNT OF VISIT PER YOUR PLAN CONTRACT.
MEDICARE VISITS
$3000 THRESHOLD COMBINED WITH SPEECH THERAPY AND OCCUPATIONAL THERAPY. UPON REACHING THE THRESHOLD OF $3000 A MEDICAL REVIEW PROCESS WILL BE INITIATED BY MEDICARE. AT THAT POINT IF MORE ARE NEEDED WE WILL PETITION FOR YOUR CONTINUED CARE BASED ON OUR CLINICAL RECORDS AND THAT OF THE PHYSICIAN
INDUSTRIAL/WORKERS COMPENSATION VISITS
WE NEED TO AUTHORIZE VISITS WITH ONE OF THE FOLLOWING PARTIES:
ADJUSTER
NURSE CASE MANAGER
3RD PARTY COMPANY IN CHARGE OF YOUR INSURANCE PLAN
AUTO INSURANCE VISITS
BASED ON A DOLLAR AMOUNT. ONCE THAT IS MET PLEASE LET US KNOW THE FOLLOWING:
- PROVIDE US WITH YOUR P.I.P. LETTER. P.I.P. STANDS FOR PERSONAL INJURY PROTECTION. THIS LETTER SHOWS THAT YOUR AUTO INSURANCE WILL NO LONGER PAY. WE WILL SEND THAT LETTER TO YOUR HEALTH INSURANCE SO THAT THEY WILL PAY (GIVEN THAT YOU PROVIDE US WITH YOUR HEALTH INSURANCE). WE NEED TO KNOW WHAT HEALTH INSURANCE YOU HAVE TO MAKE SURE WE ACCEPT IT, AND IF WE DO ACCEPT IT, WE NEED TO KNOW IF IT REQUIRES AUTHORIZATION FOR PHYSICAL THERAPY.
Tricare/Triwest/Tristar
(IF YOU HAVE CONTRARY INFORMATION PLEASE INFORM US SO THAT WE CAN VERIFY AND CHANGE OUR RECORDS)
IF YOU WOULD LIKE TO CONFIRM WHAT WE HAVE OBTAINED, PLEASE CONTACT YOUR INSURANCE. THE INSURANCE REPRESENTATIVE WILL NORMALLY ASK WHAT KIND OF FACILITY WE BILL AS. WE BILL AS AN OFFICE OR CODE 11