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Do you bill my insurance?
Oswego Physical Therapy Clinic is a pay-at-time-of-service, out-of-network Physical Therapy provider. Client reimbursement is based on the out-of-network benefit of the individual insurance plan. We do not bill your insurance.
What is the cost for a Physical Therapy consultation?
Pricing is $150 per 60-minute Physical Therapy initial evaluation and $120 per 60-minute Physical Therapy treatment. 90-minute sessions are $180.
What is the difference between an in-network and out-of-network provider?
IN-NETWORK PROVIDER Physical Therapy clinics will negotiate with each insurance company for inclusion into each insurance network. PT clinics agree to certain stipulations and reimbursement rates in return. The percent cost-to-client is smaller —after any deductible is met.
OUT-OF-NETWORK PROVIDER clinics do not negotiate with insurers; the insurer deems them out-of-network. The overall percentage cost is higher for the client.
What is the advantage of having an Out-of-network provider?
We are not bound by any stipulations or reimbursement rates, such as concierge medical clinics which offer a different level of care (longer evaluation and treatment visits, more personalized care, no use of unlicensed personnel to provide the treatment). Improved quality of treatments may result in fewer visits overall. Oswego Physical Therapy Clinic will also not have you keep coming for more visits if you don’t need them. We are also not bound to a specific time frame to complete the allotted authorized visits in the future.
How and when are payments processed?
Oswego Physical Therapy Clinic clients pay in full for each session at the date and time of service. Various payment methods are accepted, including cash, check, health spending/savings accounts, credit card, and Venmo. You will receive a receipt emailed to you after each visit.
How can I process reimbursement with my Insurance Company?
Oswego Physical Therapy Clinic provides each client with a Superbill, which is a receipt of service, outlining:
Detailed evaluation and treatment charges and descriptors (called CPT codes)
Date of service.
NPI number.
This Superbill can then be submitted to the insurer by clients eligible for reimbursement. Clients are then reimbursed directly by the insurance company for their costs.
Any additional information such as documentation (evaluation, treatment notes) are available to the client via our online portal.
Can I use Health Savings and Reimbursement Accounts?
Because Oswego Physical Therapy Clinic is a licensed, registered medical facility, clients may use HSA or HRA accounts.
Be an informed healthcare consumer, contact your insurer
It is the responsibility of the client to verify benefits and determine if and how they are eligible for Physical Therapy benefits. While the State of Oregon is a Direct Access state, some insurers require a physician referral to pay for Physical Therapy. Other insurers may require other forms and authorization.
Increasingly, heath insurance companies require a “Prior Authorization”.
Does Oswego Physical Therapy Clinic require a Physical Therapy referral to provide treatment?
No. In exchange for longer treatment time and less paperwork, Oswego Physical Therapy Clinic does not interact with health insurance companies.
Do you provide a Superbill?
Yes, we do. Superbill documentation will be provided to clients. All other treatment documentation is accessible via the secure portal.
However, we do not:
- Verify coverage or cost to the client,
- Complete any prior or subsequent authorizations,
- Obtain reimbursement from the insurer,
- Correspond with the insurer to recommend more visits.
Oswego Physical Therapy Clinic is a direct pay clinic. Your sessions are reimburse-able as “out-of-network”. Increasingly insurance companies require a “Prior Authorization”. Don’t assume your visits will be covered.
Request for Prior Authorization
If you want reimbursement for care, here a are some steps to take:
-Step 0: Call the back of your insurance card and ask, “what is my out-of-network PT benefit?”
They will tell you about your deductible, co-pay or co-insurance, number of visits/year allowed.
-Step 1: Is a Prior Authorization required?
Oswego Physical Therapy Clinic does not request prior authorization on your behalf!
-Step 2: When you collect your superbill from me after each visit you will submit it along with the reimbursement-form to your company, directly.
Each insurance company has its own form. That plus a superbill (your proof of payment with relevant information) will let you get reimbursed.
Oswego Physical Therapy Clinic does not take responsibility for non-payment from your insurance company.
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