Can I Use My Insurance for Physical Therapy?

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Published On: September 3rd, 2020Tags: ,

About the Author: Dr. Shira Racoosin, PT

Dr. Shira Racoosin is a physical therapist with MovementX in Washington, DC.

Using insurance for care with a physical therapist can get complicated. We’re here to keep it simple.

MovementX Physical Therapy Portland

At MovementX, our goal is to simplify the payment and overall experience behind high-quality physical therapy care. Before ever booking a session with one of our specialized physical therapists, you will have full transparency in how much a session costs and whether or not insurance will reimburse you.

Are we the cheapest option in town? Not always, but there are substantial cost savings when you receive high quality, personalized care from expert physical therapists who are fully invested in helping you achieve your goals.

How does out-of-network care enable a better experience?

At MovementX, we have a vision of a world healed by movement. We want to deliver the highest quality physical therapy care and personal training services to anyone in need. To do so, we have gone beyond the world of insurance to help provide a better experience for you as the patient.

Being out-of-network allows MovementX physical therapists the autonomy to provide highly personalized, expert care where you need it most (at work, in home, outdoors, at your gym) without the unintended consequences that traditional clinics bear due to insurance contracts.

  • If you have a high deductible plan and will be paying cash towards your deductible, our upfront rates and bundle package discounts are often lower than in-network rates.

  • If you have met your out-of-pocket maximum for the year and your insurance is paying 100% of your healthcare bill, in-network and out-of-network clinics may be covered at the exact same rate.

  • If you don’t have health insurance at all and are looking to pay cash, our upfront rates and bundle package discounts are often lower than a traditional clinic.

Does my insurance plan have out-of-network benefits?

Most major insurance plans have some level of out-of-network coverage. This will vary based on the insurance carrier and your employer.

Want to know exactly what type of out of network benefits you have? Click the button below and a member of our insurance team will look them up for you.

Verify My Benefits
  • We also work with all car accident claims and select workers compensation claims. Fill out the form above and we’ll check to see if your claim qualifies.

  • At this time, we do not work with Medicare Part B or Supplemental plans for physical therapy care. However, we do work with select Medicare Advantage plans and are happy to offer wellness services on an out of pocket basis.

How does out-of-network care at MovementX work?

  • Step 1 Verify Your Benefits: Submit your insurance information via this secure form and a member of our insurance team will verify your out of network coverage for physical therapy, including your accumulations towards your deductible.

  • Step 2 Pay for Your Session: In most cases, your physical therapist will collect the cost of the session in full after the session is complete. You will then immediately receive an email with a link to your receipt, which has been fully itemized with all the information the insurance needs to process your claim.

  • Step 3 Submit for Reimbursement: In most cases you can submit for reimbursement on your insurance web portal. If you do not have web portal access, you can call your insurance and request a “Member Claim Form” which you will attach to your MovementX receipt and mail to the insurance company.

  • Step 4 Get Paid: Your insurance will write you a check and mail it directly to you for the portion of the session that is reimbursable.

Physical therapist stretching patient with hypermobility syndrome in Portland, OR

More FAQs About Using Insurance for Physical Therapy

Most insurance plans do not require a referral to be seen by a physical therapist. When we verify your insurance information, we will confirm whether or not your specific plan requires a physician script.

If you are using your workers compensation or car accident coverage, you will need a script from your managing physician. Physician scripts and medical charts can be faxed to (888) 645-6068.

Sometimes! Some insurance plans such as Regence BCBS and CareFirst Maryland require prior-authorization to be obtained prior to starting care.  When you fill out the insurance verification form, we will check to see if prior-authorization is required. If prior authorization is not obtained prior to starting care, your reimbursement request will be denied by the insurance company.

Please note that while we always do our best to flag prior-authorizations, we cannot guarantee that we will determine if prior-auth is needed prior to you starting care.  Ultimately it is the patient’s responsibility to check if it is required and you can do so by calling the customer service number on the back of your card.

If you believe a prior authorization is required, please contact us at info@movement-x.com and we will happily submit on your behalf.

Every insurance company pays a different amount for an hour of physical therapy. At MovementX, we have set our hourly rate at $150-$200. Your out of network reimbursement will be based on what the insurance determines as their hourly rate, and not based off of MovementX’s hourly rate. If the reimbursement rates of the insurance company are less than our hourly rate, you will not be reimbursed for the balance by MovementX. The difference between what we charge and the insurance company reimburses is called a “balance bill.”

Every day our profession is fighting to prove our value to insurance companies so they can increase our reimbursement rate, and therefore save you money. Help us advocate for our value by writing to your insurance company about the value you have found out of PT.

Yes! We have physical therapists who specialize in whiplash, acute injuries after car accident, post-operative care, and slips, trips, and falls personal injury cases. The convenience of our mobile model makes MovementX a perfect option for you. If you are interested in using your PIP for care, please contact us at info@movement-x.com or call (971) 361-9442 to begin your case.

Yes! We gladly accept Health Savings Accounts and Flex Spending Accounts for physical therapy care. When setting up your profile, input your HSA or FSA debit card as your payment method or submit your invoices directly to your employer or HSA/FSA provider for reimbursement. FSAs often expire at the end of the year, so don’t let it go to waste!

Why do you need my payment information prior to my first session?

Providing your payment information prior to care ensures that you are 100% ready to be evaluated and treated by your expert provider, leaving your provider to focus solely on what matters most- you and your care. Not only does this streamline our operations, it makes receiving care more convenient for you.

When will my card be charged?
The only time we process a charge on our system is after you receive services with us and have agreed upon a set price with your provider. After a charge occurs, you will always receive an email from MovementX with a link to your receipt.

Where do you house payment information?
Our priority is keeping your credit card secure. That is why we utilize a widely used third party payment processor to anonymously store your credit card information. No credit card information is stored on our website or platform and no one, except for you, has access to its data.

Can I speak to someone before entering my card information?
Absolutely! We are happy to discuss processes further or set you up with a free consultation with one of our expert providers. Please call us at 971-361-9442 or email us at info@movement-x.com so we can provide further assistance.

Every insurance company has a slightly different process for submitting for reimbursement. If you have access to an online portal through your insurance company, this is likely the easiest way to submit your claim. If you do not have online portal access, call the member services number on the back of your insurance card and ask for a “Member Claim Form” and a claims mailing address. Attach your receipts from MovementX to your Member Claim Form and put them in mail!

As soon as your session is processed by your physical therapist, your card on file will be charged and you will receive a link to your session receipt via email. You can also access your receipts by logging into your patient dashboard and clicking “sessions” in the upper right hand drop down menu.

If you receive any notification about an issue with a claim, please forward it to our insurance office at info@movement-x.com and we will work with you and your insurance company to fix any errors and help you resubmit the claim. Please note that we do not guarantee payment, but will do our best to fight for your reimbursement!

After we verify your insurance, our insurance office will email you with your out of network physical therapy coverage, which can be full of words that even the highest scholar doesn’t understand. So what do all these insurance words mean?

  • Deductible: the amount you pay for health care services before your insurance plan starts to pay
  • Co-pay: The fixed upfront costs associated with an office visit
  • Co-Insurance: The percentage of costs of a health care service that your insurance will pay after you’ve met your deductible.
  • Out of Pocket Maximum: The maximum amount you pay out of pocket until insurance starts to cover 100%

We wish we could! MovementX is considered “non-enrolled” in Medicare, which means we have no relationship or contract with Medicare.  While third party Medicare Advantage plans do have out of network coverage, traditional Medicare Part B and Medicare Supplemental plans do not. This means that we do not bill and our clients cannot submit for reimbursement to Medicare Part B.

Unfortunately, due to Medicare regulations, PTs are not allowed to accept cash for restorative physical therapy sessions focused on pain relief, recovery of function, and post surgical rehabilitation.

We are, however, allowed to see you for the following reasons:

  • Wellness and Optimize Sessions aimed at helping you move better, perform at a higher capacity, and become more resilient to injury. (Medicare does not care if you pay out of pocket for this because services are not considered medically necessary!)

  • Physical therapy services after Medicare has denied further visits at an insurance based PT clinic.

  • Our AgeProofYourBody exercise class series.

Conclusion

Physical therapists who operate out-of-network are able to provide you with more personalized and professional care.

Depending on your insurance plan, you can use your out-of-network benefits to cover part or all of the costs of care at MovementX.

Check My Benefits
CONTACT US

About the Author

Dr. Shira Racoosin Physical Therapist with MovementX in Washington, DC

Dr. Shira Racoosin is a physical therapist with MovementX in Washington, DC. She is residency-trained in orthopedic physical therapy, certified in dry needling, and has a special passion for helping older adults live more active lives. Dr. Racoosin is a published author on manual therapy interventions for patellofemoral pain and deeply cares about empowering you to move your body better.

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