Insurance & Benefits of Receiving Treatment at a Cash Based Practice

Insurance & Medicare

 Insurance is not filed by our office.  Please read below to better understand the reasoning.  

However, we have partnered with a company called Reimbursify

You can download their app on your phone, answer a few questions, upload photos of your receipts and they do the work for you. Amazing part, it only cost $2 each claim. After you fill out all the details the first time, you click "clone claim" and you are good to go. You can do this for any doctors office you see who do not file claims directly.  If requested we provide you with all the necessary codes needed. 

We are an out-of-network provider with all insurance plans. 


Medicare 

Evolution Physical Therapy is not a Medicare provider. Law prevents us from providing Medicare patients with what would be considered "normally covered services." This includes Medicare as a primary or secondary policy. If you have a REPLACEMENT policy, please contact your insurance directly to gain more information. Please let them know we are NOT a Medicare provider and confirm your claims are not sent to Medicare for any portion of coverage. If you are a Medicare beneficiary and would still like to request treatment at our clinic, please call the office directly.

Determine Coverage

If you'd like to know what your insurance will reimburse before you submit claims, please click below.  We have provided a downloadable PDF file with a list of questions you can ask your insurance company to help determine your coverage.

FAQ's

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· Why don't you accept insurance?

Insurance is not filed at our location because the business model necessary for an insurance-based PT practice does not support the treatment model we follow. What does that mean for you? In standard physical therapy practices, insurance reimbursement requires a therapist to see 2+ patients at a time and utilized aides or technicians to apply passive modalities and administer exercise programs. 


This must be done because insurance companies tend to reimburse less than is billed and accepting insurance increases cost by adding the additional staff needed to handle claims. We do not believe in or agree with having our patients receive passive modalities and perform exercises they can do at home, when the time is convenient for them. In many ways, insurance companies dictate, or at least influence the care and time the patient receives, and we refuse to let our patients receive sub-par care.  


Returning you to full function faster with true one-on-one care will save you money on fewer visits and by getting you back to life sooner. If you really examine what your insurance pays, paying out of pocket for technologically advanced physical therapy is the best option!

· I only pay $40 per visit for in-network providers. Why would I pay $140 per visit to see you?

 A typical physical therapy office requires you visit 2-3 times per week. A co-pay of $40 is $120 a week. For slightly more, you only need to see us once a week. This saves you a great deal of time driving to and from visits as well as taking time off from work or family.  


More importantly, in a typical PT office you are seen with several patients at the same time.  You see the Physical Therapist for a few moments and are passed to a tech and released into a general gym space to complete your generic one size fits all exercises.  ALL sessions with us are one-on-one with the Physical Therapist and  each person receives a customized plan to fit THEIR needs.

· Why only once a week in our office?

 It is our belief that you should not pay to have someone watch you do your rehab treatment exercises. These can be done at home on your own schedule at your own pace. Each week you will receive treatment as well as an evaluation of your current exercises. Changes will be made as needed to progress your treatment goals.

· What is the patients benefit of a cash based practice?

There is a large benefit to receiving cash based physical therapy and the biggest benefit for the patient is the fact that we MUST succeed in order for you to find value in our service. 


With that being said, we WILL NOT waste your time or your money! You will know after the initial evaluation or within 2-3 visits if you find value in the care you will receive from our therapists. The majority of our new patients leave their first visit feeling relief they've never been able to receive by other therapies. 


Additionally, 100% of our practice is fueled by word of mouth marketing. If you are not happy with our service, it reflects poorly on us when we are unable to provide you with the care and results you need.  Bottom line, our practice suffers.

· I've never submitted my own visits, how is that done?

Each insurance company is different. Some companies will allow you to simply submit the receipt you receive from us with your member information written on the receipt. Some require you fill out a form specific to them to include with your receipt. If your form requires a doctor signature, please let us know. We are happy to provide that at any time. Forms/Receipts are then mailed to the address on the back of your insurance card, faxed or uploaded in your insurance portal.  OR read below about the  AMAZING service Reimbursify.com.   If you will be submitting to insurance please let us know and you will be sent an insurance specific receipt with the necessary codes.

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We have found an AMAZING company who submits your claims for you for only $1.99 per claim!  They submit the claim, track everything, and help with rejections!


How does it work?

 "It’s simple: you see your out-of-network healthcare provider and pay for the visit. They will give you a detailed receipt (known as a “superbill”) that has the necessary information on it to file a claim with the Reimbursify app within minutes. The app will alert you when the claim has been received by your insurance company and then again when you should expect your reimbursement check in the mail (usually within 2-4 weeks). That’s it! There are no forms to fill out, nothing to fax or mail, and nothing to remember. " -  “Reimbursify.” FAQ, https://reimbursify.com/#faq. 

· What do I need ask my insurance company about coverage?

If you'd like to know what your insurance will reimburse before you submit claims, please click below.  We have provided a downloadable PDF file with a list of questions you can ask your insurance company to help determine your coverage. 

How much will I be reimbursed?

  This information is to better help you understand insurance coverage.
ALL insurance companies are different, and this information is in NO way a guarantee of how your policy works. Click the blue box above for questions to ask your insurance company to determine your plan specific benefits.


· A deductible must be satisfied before the insurance company will pay for therapy treatment. 


· The reimbursement percentage will be based on your insurance company’s established “reasonable and customary” price for the service codes rendered. This price will not necessarily match the charges billed. Some may be less, some may be more. Example: If they consider a reasonable and customary price for code 97140 to be $30 and they pay 60% of charges, they will pay $18 of the $35 we change. If they feel it is worth $40 and pay 60%, they will typically give you the full $24, not 60% of what we charge.   TYPICALLY, but all insurance companies as well as insurance specific plans are different.


·   Typically insurance plans will pay for either a maximum number of visits or a specific dollar amount per year.  Typically you can ask for additional visits if deemed 'medically necessary'.   


· If your policy requires a prescription from your PCP you must obtain one to send in with the claim. Each time you receive an updated prescription you’ll need to include it will the claim.  This is typically not necessary in Arizona.


· If your policy requires pre-authorization or a referral on file and the insurance company doesn’t have one listed yet, you’ll need to call the referral coordinator at your PCP’s office. Ask them to file a referral for your physical therapy treatment that is dated to cover your first physical therapy visit. Be aware that referrals and pre-authorizations have an expiration date and some set a visit limit. If you are approaching the expiration date or visit limit you’ll need the referral coordinator to submit a request for more treatment. 

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