REFERRAL OPTIONS
No physician referral (also known as a prescription or “script”) is required for physical therapy treatment in Florida, except for Medicare-covered services. Please ask your physician’s office to fax your referral to 239-395-5857 if applicable. Please note that having a referral from your physician for services does not require us to file claims if we are out of network or if such services are considered wellness or non-covered.
MEDICARE
We are participating providers for Medicare Part B. We provide Medicare covered services for acute/new conditions or exacerbations of progressive or chronic conditions, typically up to 15 visits. Visits covered sessions are self-pay through our Wellness/Maintenance Program (see below).
You will be billed for any deductible or coinsurance not covered by your supplemental plan. Please check your policy for details as coverage can change annually. If you have changed your plan and no longer have active Medicare Part B, you will be responsible for our flat-rate fee.
Documentation of discharge date will be required from your home health agency if you have recently received home health services. If you are receiving any home health agency services covered by Medicare Part A, we will NOT be able to bill Medicare Part B concurrently, and you will be responsible for the charges at our flat-rate fee.
MEDICARE WELLNESS/MAINTENANCE PROGRAM
This discounted program is available for Medicare patients desiring continued sessions, typically for chronic conditions, assisted exercise with home program, balance and gait supervision, modalities and wellness consultation. Since Medicare does not cover wellness services, this option is perfect for patients wishing to maintain their level of function, mobility, pain-relief and balance. You will continue to work with your physical therapist on a one-on-one basis. This option also suits patients who have difficulty complying with a home exercise program or have safety concerns with exercising at home. The number of visits and frequency of visits is entirely up to the patient. A Medicare Advanced Beneficiary Notice (ABN) will be provided as we will not bill Medicare for these non-covered services.
OTHER INSURANCE
For insurance other than Medicare Part B, we require payment of our flat-rate fee at the time of service and will not balance-bill above this rate. If desired, we can file claims as a courtesy for all major PPO insurances out-of-network, including Medicare Advantage and Replacement Plans. We are required by law to collect any patient responsibility amount (co-insurance, co-payment, deductible) determined by your insurance. Reimbursement we receive (after patient responsibility is met) will be sent directly to you once all insurance payments are received. Some insurance companies will send checks directly to patients.
MEDICARE REPLACEMENT AND MEDICARE ADVANTAGE PPOs / HMOs / EPOs
Some of these plans may have lower premiums than traditional Medicare Part B but may carry higher costs for therapy services. Unless there is no network applicable or the out-of-network deductible has been met, you will be billed for the flat-rate fee. If there is an out of network deductible, you will be billed for the flat-rate until this deductible is met and then will be billed for the estimated co-insurance rate. Please check your policy to ensure no surprises. Although a plan may have “Medicare” in the name, it may be an out-of-network provider with us or have no coverage in the case of an HMO.
SELF-PAY PLAN
We offer a flat-rate fee for all individuals who pay at the time of service in our clinic. This ensures a full 40- or 60-minute treatment, one-on-one with your licensed physical therapist, including manual therapy, education, modalities and instruction in home program or activities. This option is advisable for those with high-deductible plans, HMOs or no insurance. We are also happy to provide a detailed receipt/superbill for those who choose to file their own insurance. In Florida, a physician prescription is no longer required.
MASSAGE COVERAGE
If you have written confirmation of your insurance plan covering massage therapy visits, we will print you a detailed receipt/superbill for each visit. You can then submit this form to your insurance company for reimbursement.
AUTO INSURANCE
Covered benefits from auto insurance following an accident vary. If you have been in an accident and have a physician’s referral for physical therapy and/or massage therapy, we will be happy to process your claims. Please note that payment of our flat-rate fee is due at the time of service and will be reimbursed to you once claims are covered by the insurance company.