Medicare
Medicare, in plain words
Most people who come to us have Medicare. Here is how it fits with physical therapy.
What Part B helps pay for
Medicare Part B can help pay for outpatient physical therapy when your therapist and your doctor agree it is needed. Your therapist writes the plan of care, and a physician or other qualified practitioner signs it.
What you pay
After the yearly Part B deductible, Medicare pays its share and you pay the rest, called coinsurance. A Medigap plan or a retiree plan may pay that share for you. We tell you which applies before your first visit.
If you have Medicare Advantage
These plans set their own rules, such as a referral or an approval before care starts. We call your plan first and tell you what we learn.
If you want care at home
Medicare Part B can cover outpatient PT at home if you are not getting home health at the same time. If a home health agency is already visiting you, tell us and we will explain what changes.
Keeping the plan up to date
Medicare asks that your plan of care be signed and reviewed from time to time. We send the paperwork to your doctor and keep track of it for you.
What to bring
Your red, white and blue Medicare card, and any other plan or supplement card.
How fees work
What you pay depends on how you pay. Each answer is here in plain words, and the front desk goes through yours before your first visit.
Insurance we work with
We bill Medicare and many other kinds of plans. Your Medicare Advantage or other plan may have its own rules, and we tell you before you book whether we are in network with yours. The front desk checks your plan card.
Medicare
Most PPO plans
Medicaid
Medicare Advantage plans, case by case
If you pay yourself
If you do not use insurance, you pay on the day of each visit. We tell you what to expect before you book. If cost is a worry, tell the front desk and they will go through your choices.
Receipts for reimbursement
If your plan may reimburse you, we give you an itemized receipt, called a superbill, to send in. The plan decides.
An estimate in advance
If you pay without insurance, we give you a written Good Faith Estimate before your first visit: what we expect each visit to include. If a bill comes in $400 or more above the estimate, you can dispute it.
Our front desk checks your benefits and calls you with what they find, before your first visit. Your plan has the final say on what it pays, and your deductible, coinsurance or copay is set by your plan.
Questions about paying
Does my plan cover this, and do you take Medicare?
Yes, we bill Medicare, and we bill many other kinds of plans. Your plan decides what it pays. We check your benefits and call you before your first visit.
What if I pay myself?
We give you a written estimate before your first visit, and you pay for each visit on the day. If your plan may reimburse you, we give you a detailed receipt to send in. Your plan decides whether it pays.
Do I pay when I come in?
We tell you what to expect before you book. If you have a deductible or coinsurance, the front desk explains it before the first visit.
What if I have both Medicare and another plan?
Tell us about both. We check how they work together and tell you what we find.
Want to know what to expect?
Call the front desk with your cards in hand. They will go through it with you, or with your son or daughter.
You can also ask for a written estimate.