REFERRAL OPTIONS

No physician referral (also known as a prescription or “script”) is required for physical therapy treatment in Florida, except for Medicare patients.  Please ask your physician’s office to fax your referral to 239-395-5857.  Or you may bring a written referral to your first visit.  If your physician recommends a different clinic, you may still request us, and we will accept the original referral.  Your physician may be unfamiliar with our services, or refer you to a clinic that is not in a convenient location.  It is your right to see the provider of your choice. 

MEDICARE

We are participating providers for Medicare Part B, and Medicare supplemental/secondary insurance plans.  This means that we will not bill Medicare patients higher than the Medicare allowable rate, and we will submit claims for you directly without requiring payment at time of service.  Some supplemental or secondary plans cover the Medicare deductible and remaining 20% co-insurance  not covered by Medicare.  Others will require the Medicare deductible and/or a portion of the co-insurance to be paid by the patient.  This will be billed to you once insurance claims are processed.  Please check your policy for details. 

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.  Documentation of discharge date will be required from your home health agency if you have recently received home health services.

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.  We are in network with many Medicare plans, however we (and other local therapy providers) may be out of network with the primary carrier, which will result in a different co-payment or co-insurance, high deductible or no coverage at all.  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.

OTHER INSURANCE

We accept all major PPO insurances (including Aetna, Anthem, Banker’s Life, BCBS, Cigna, Colonial Penn, Commonwealth, Continental Life, Empire, Golden Rule, Humana, Tricare, Railroad Medicare, United Health Care) and will file your claims as a courtesy.  We are out-of-network with non-Medicare plans, so please check your out-of-network deductible and co-insurance benefits.  We require payment of our flat-rate fee at the time of service, unless your out-of-network deductible has been met.  We are required by law to collect any patient responsibility amount (co-insurance, co-payment, deductible) determined by your insurance, but will not balance-bill above our self-pay rate.  Rest assured that any reimbursement for claims we file on your behalf (after patient responsibility is met) will be sent directly to you, or reimbursed by us within 30 days, once all insurance payments are received. 

AUTO INSURANCE

 

Covered benefits from auto insurance following an accident vary,  If you have been in an accident and have a physicians 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.

 

HOME VISITS

 

As home visits require travel time that would otherwise be used to treat patients in the clinic, an additional travel fee will be added to any scheduled home visits, based on distance from the clinic.  Please note that during high season and pending therapist availability, we may not be able to accommodate home visits.  If you are concurrently receiving home health services under Medicare Part A, our flat-rate fee will also apply. 

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 paperwork for our international patients, or for those who choose to file their own insurance.  In Florida, a physician prescription is no longer required.

MAINTENANCE PROGRAM

This discounted program is available for Medicare patients desiring continued sessions once therapy goals have been met.  Since Medicare does not cover wellness maintenance services, this option is perfect for patients wishing to maintain their level of function, mobility and balance.  You will continue to work with your physical therapist on a one-on-one basis, including manual therapy, modalities and skilled supervision of balance activities.  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.