Insurance Information

All Treatments Billable to Insurance:

All of our our providers at Andersonville Physical Therapy are licensed physical therapists. Therefore, all of the treatments we provide are billable to insurance. Even our specialty services, such as Pilates or yoga therapy, can be billed as physical therapy when performed by a physical therapist and approved.

Accepted Insurance Plans

PPO
  • Blue Cross/Blue Shield
  • Medicare
  • Aetna
  • Cigna
  • Coventry
  • PHCS
  • Beech Street
  • Humana
  • Preferred Plan
  • Admar Med Network
  • Evolution Healthcare Systems
  • Galaxy Health Network
  • Fiserv
  • United Health Care
  • MagnaCare
  • Assurant
  • UMR
  • Franciscan Alliance
  • Global Excel Management
  • HPHC – Harvard Pilgrim
  • PHCS
  • Preferred One
  • Union Pacific Railroad
HMO
  • Aetna
  • Cigna
  • Humana
  • United Healthcare
  • Health Care Support
  • HPHC – Harvard Pilgram
POS
  • Blue Choice
  • Aetna
  • Cigna
  • Humana
  • Health Alliance
  • Healthlink
  • NALC Health Benefit Plan
  • Harken

All Workers’ Compensation Insurance Accepted

Insurance Guide

Here are some useful definitions and information to help you understand your insurance coverage:

DEDUCTIBLE: A deductible is the amount you pay for healthcare services before your health insurance begins to pay their contracted amount.

For example, if your deductible is $1,000, you must pay for health services rendered until that full amount in billable health services is reached. After that, you will typically share the cost with your plan by paying coinsurance and/or co-pays before your insurance company begins to pay a contracted portion for your health care service.

COPAYMENT: A copay is a fixed amount you pay for a health care service, which can vary by the type of service. You may also have a copay when you get a prescription filled. Physical therapy copays tend to range between $20 and $50. Copays are due at the time of service.  

COINSURANCE: Once your deductible has been met, your insurance company will begin paying for a percentage of your care, and you will be responsible for coinsurance. Coinsurance is your share of the costs of your health care service after your insurance pays their portion. For example, once your deductible is satisfied, if the covered charges are $300 and if your co-insurance ratio is 80%/20%, your insurance company will pay $300x.80=$240, and you will be responsible for $300x.20=$60.  When you call your insurance to verify your benefits, the coinsurance rate quoted is usually the percentage that the insurance company will pay.

OUT-OF-POCKET MAXIMUM: After you have paid this total dollar amount in copayments, deductibles, and co-insurance, your insurance will pay 100% of the cost of all covered services (often up to a stated maximum).

PRECERTIFICATION/PREAUTHORIZATION: Most insurance plans now require precertification for physical therapy. This means that, based upon your individual case and the data submitted by your therapist (your pain level, loss of strength and motion, etc.), your insurance company will determine in advance how many visits will be covered. Once those approved visits are completed, it is typically possible for the therapist to submit updated data to get approval for another set of PT visits*.

*Please note that some insurance companies require that the set of approved visits be used by a certain date. Even if your insurance company allows a certain number of visits per plan year, not all of these may be granted based upon the status of your case and progress that is made in physical therapy.

Please remember that these are basic guidelines and that every insurance company and plan has different and specific nuances. When in doubt, contact your insurance company directly to obtain details about your specific plan. (It is always a good idea to contact your insurance company directly to verify).

MEDICARE Part B coverage details

DEDUCTIBLE: The set dollar amount you must pay in billable health services before your co-insurance takes effect. In 2017, the Medicare Part B deductible for all participants is $183. If you have a supplemental insurance policy, it may cover the Medicare Part B deductible. Please contact your supplemental insurance company for more details.

COINSURANCE: After you have fully paid your $183 deductible, Medicare will pay for 80% of your physical therapy bill, and you will be responsible for the remaining 20%. If you have a supplemental insurance policy, it may cover this remaining 20% in coinsurance. Please contact your supplemental insurance company for more details.

MEDICARE CAP: Each calendar year, Medicare sets a specific dollar amount that each Medicare Part B participant is granted for physical therapy and speech therapy combined. For 2017, this amount is $1,960.00. At Andersonville PT, this generally comes out to around 20 visits per calendar year, give or take (the exact number of visits will vary based upon billing for each session).

EXCEEDING THE CAP: You may exceed the $1,960 cap, up to $3,700, if physical therapy is medically necessary and you are continuing to improve in your care. To continue care after you have exceeded the $3,700 maximum, your case will be reviewed by Medicare, and you will need to sign an “Advance Beneficiary Notice of Noncoverage” (ABN).  By signing this form, you acknowledge that if you continue to have therapy services beyond the cap and Medicare does not deem it medically necessary, you will be financially responsible for those charges.

HOW MUCH OF MY CAP HAS BEEN MET? Your therapist should be able to tell you how much of your Medicare cap has been used for the calendar year for services provided here at Andersonville PT. If you have had therapy services elsewhere in the same calendar year, we may not know the exact amount used. In this case, you can always call Medicare to inquire at 1-800-MEDICARE (1-800-633-4227).