Insurance

Insurance

Premier Physical Therapy accepts many insurance plans, PPO’s, HMO’s, workers’ compensation networks, and automotive insurances. Please contact our front desk for an up to date list of our insurance contracts. We will verify your insurance benefits before you come in for your appointment so that you will know the cost of each Physical Therapy sessions. However, it is always recommended that you also contact your insurance company to better understand your benefits and ensure that the information we receive matches that information you are given in order to prevent over or under collection at the time of the appointment.

We also offer a self/cash payment option for those that are out of network or do not want to use insurance. Our prices are as follows:

    Initial eval: $ 104 One hour session: $ 78 Half an hour session: $ 52

Disclaimer: Your insurance reserves the right to adjust your benefits at any point in time and your benefits are determined at the time the claim is received.

Some insurance terms you may want to know:

  • Deductible: a specified amount of money set by your insurance that you must pay before they pay any claims.
  • Co-payment/Coinsurance: a specific amount set by insurance that you pay at each visit with insurance covering the remaining amount of charges for that visit.
  • Prior-authorization: Certain insurances require that we submit for authorization for visits. They typically give a date limit and/or a certain number of visits allowed. If more visits are required beyond what they set, we can request for more.
  • Out of Pocket Maximum (OOPM): Amount of money insurance has set that you have to pay out of pocket in any given policy/calendar year. They are both for in- and out- of network OOPM. Some plans do include this in the deductible or co-payments but others do not.
  • Visit Limitations: Some insurance companies put a limit on the number of visits they will allow for each policy/calendar year. If the visits are based on Medical Necessity (this means your therapist and doctor agree that services are medically necessary) then the insurance company will most likely cover the service. However, this is not guaranteed.
  • Policy Year vs Calendar Year: Policy Year: 12-month timeframe that does not follow along with a calendar. This means that your deductible does not start over at the beginning of the year (i.e. January), it means that it will restart when your policy year starts over. Calendar Year: follows the traditional calendar year (January-December)
  • Referral Requirements: Some insurances do not require a referral from a physician for 30 days of treatment, while others do require a referral with no exceptions. Ex: Medicare requires a referral from a physician (Cannot be a dentist, chiropractor, etc.) In Florida, a referral is required by a physician after 30 days of treatment for a condition not previously assessed.
  • Direct Access: In Florida, a patient can come to therapy without a referral from a physician for the first 30 days of treatment for a condition that was not previously assessed. If treatment is required after the 30 days a practitioner of record (a primary care physician is fine) must review and sign the plan.
  • Hosptial vs Professional/Office: Benefits can change depending on the setting of the physical therapy clinic.
  • Assignment of Benefits:  This is our best estimation of your insurance benefits based on what the insurance company has told us.