Questions About Insurance and Referrals
“You don’t take my insurance so I can’t come see you.”
This is actually not true. We may not be in-network with your insurance, but you can still come see us. When you see us, you pay for the visit up front, just like going to the chiropractor or to have a massage. And just like going to have a massage, you don’t need a referral and you don’t have a limited number of visits. You come when you want and for as long as you want. After you see us, we provide you with a receipt. You can file that receipt with insurance so you can be reimbursed or have that amount applied to your deductible. This is insurance dependent, you can call your insurance provider to find out how to do this and if they will help you.
“Going to an out-of-network provider means I get surprise bills later and it costs an arm and a leg.”
This is also not true. Our fees are up front, you get what you see. There will never be a surprise cost or a surprise bill. The only thing that may surprise you is our fees are actually cheaper than your co-pay. Evaluation $75, follow up $50. That’s what you can expect to pay. Period.
“I need a referral.”
You do not need a referral. Referrals are something insurance companies ask you to get, but they are not something we will ask you to get. You can call and schedule an appointment at any time. Do you have knee or shoulder pain? You can walk in and have your rehab without ever stepping into your physician’s office. We are fully capable of checking you out and finding out what’s wrong without using an x-ray or other fancy scan. If we check you out and think you could benefit from an x-ray or fancy scan, we can let you know and have you go see your physician. But most of the time, you don’t need those things to find out what’s wrong and to get on track to getting better. So you can save yourself the extra day off work, skip getting the referral, and make an appointment with us first.
“I have to know what’s wrong before I come see you.”
Medical doctors aren’t the only people that can figure out what’s wrong with your body. In fact, most doctors specialize in knowing what makes you sick, but not why your body hurts. Athletic trainers and physical therapists study specifically to know why your body hurts. You can come into a visit with us not knowing what’s wrong, and leave your visit knowing exactly what’s wrong and have a plan to get better. So if you don’t know what’s wrong, come see us, let us help you figure it out!
How Best to Work with Us Based on What Insurance You Have
You pay a lot each month for your health insurance, so you want to use it as much as you can. We totally agree! Using a physical therapy place that is not in-network with your insurance sounds daunting and it can sound like a bad idea with surprise fees and a lot of hassle. We get it and we do everything we can to prevent that. Here we have some information that can help you make the best decision you can!
When you have a referral: Tenncare covers the full cost of every visit as long as you have a referral, therefore if you have Tenncare working with an in-network provider would be best, especially right after an injury or surgery. However, because it is a government insurance, they are able to lay heavy restrictions on your plan of care. So you may not get as many visits as you need. When you run out of visits, if you feel like you could use more rehab, this would be a good time to come see us! We offer cash visits for less than your typical PT provider and there is never a restriction on how many visits you can have. So start with in-network and if you run out of visits come see us! You won’t need a referral to come see us. Referrals are something insurance companies want, not something we need.
When you don’t have a referral: If you don’t have a referral or feel like you can’t get one, you can come see us and pay cash. In this case, Tenncare is not involved at all. Come see us when you want, for as long as you want. No bills from Tenncare. No hassle.
These plans can be complicated. Here we are going to try to make it as plain and simple as we can. Here is how that typically shakes out:
Working with an IN-network provider
Your PT wants to see you 2-3x/wk for 8 weeks = about 20-24 visits
Most PTs will see you 3x a week at first and then dial your plan back to 2x a week.
Typical cost per visit at local PT clinics: $85
Deductible = $1200 (that means your deductible will be met after 15 visits)
Week 1: $85 x 3 visits = $255
Week 2: $85 x 3 visits = $255
Week 3: $85 x 2 visits = $170
Week 4: $85 x 2 visits =$170
Week 5: $85 x 2 visits = $170
Week 6: $85 x 2 visits = $170 ($1,190 toward deductible)
Week 7: $10 for visit one + billed to insurance for visit two = $10
Week 8: Billed to insurance x 2 visits = $0?
You meet your deductible by week 7, meaning you pay $10 for the first visit to meet the $1200 deductible. The rest of visit one and all of visit two for week 7 is billed to your insurance. You insurance decides what to pay, you pay the difference. The two visits for week 8 are billed to insurance, insurance decides what to pay, you get billed the difference.
You’ve completed PT. You paid $1200 + whatever is billed to you next month from weeks 7 and 8. We are unable to fully know the cost for weeks 7 and 8 because your insurance company looks for reasons not to pay for your visits. (That’s how they make money).
The above information is accurate if you have a $1200 deductible, and haven’t had anything else applied to your deductible during the year.
If your deductible is less or if you have other doctor visits applied to your deductible you will meet it sooner and have more billed to your insurance. You will likely pay less, but we cannot estimate this as we do not know what your insurance will agree to cover.
If your deductible is more, you will have to pay for more visits out of pocket before your services are billed to insurance, therefore you will pay more.
Working with us
Here we show a plan done with us that is comparable to the one above. The visits are set the same as above, but we rarely see patients 2x a week. We integrate our plans into your schedule and your lifestyle so you don’t have to be in the clinic 2-3x a week to get the benefits. Strictly by appointment, an evaluation is $75, and all follow-up appointments are $50. If you were to see us the same amount as the above, in-network:
Week 1: $75 evaluation + ($50 x 2 visits) = $175
Week 2: $50 x 3 visits = $150
Week 3: $50 x 2 visits = $100
Week 4: $50 x 2 visits = $100
Week 5: $50 x 2 visits = $100
Week 6: $50 x 2 visits = $100
Week 7: $50 x 2 visits = $100
Week 8: $50 x 2 visits = $100
Total you paid: $525 for the first month, $400 for the second month. Total: $925
Again, we rarely see patients more than 1x per week. If you see us 1x per week, the totals come down to $225 for the first month and $200 for the second month, totaling just $425! That means you can see us for a whole month for less than just one week with an in-network PT. We also provide you with receipts for your visits so you can file those receipts with your insurance to be reimbursed or to have them applied to your deductible. (This is insurance dependent, we suggest you call your member services number on your insurance card to learn more about your benefits)