![]() ![]() What steps are involved in submitting a claim to my insurance company? Please make sure you understand the terms and conditions of the reimbursement eligibility and process through your insurance provider. Reimbursement benefits vary from company to company. Insurance companies reimburse patients according to their out-of-network benefits. In the case of cash-based services, it is the patient who is waiting for reimbursement rather than the provider.ĭisclaimer: Tidal Sports Recovery & Rehab provides the required documentation, but is not responsible for reimbursement processing. Many patients choose to receive services out-of-network in order to see the physical therapist of their choice. ![]() Going out-of-network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide payment for services received "out-of-network". It is the patient's responsibility to do so and also to provide payment in full, up front, at the time services are rendered. There is no guarantee that your insurance company will reimburse you for the services, however, Tidal Sports Rehab & Recovery can provide you with the paperwork necessary to submit your claim. ![]() Possibly! It is possible for insurance companies to reimburse patients depending on the individual provider and plan. Is it possible for my insurance company to reimburse me? It is important to note that in-network provider status is not currently based on education, experience, skills, or treatment outcomes, but is often determined by the number of providers in a demographic area. There are MANY insurance companies, each with their own contracted rates and regulations, and Tidal Sports Rehab & Recovery’s energy is best spent working with patients. This simply means that the therapist has not entered into a contract with individual insurance companies to receive reimbursement based on their contracted rates. Tidal Sports Rehab and Recovery is an out-of-network provider- what does this mean? Documentation for evaluations, treatment visits, and progress notes are performed just like any other physical therapy practice and comply with all legal requirements. Cash-based billing eliminates this confusion and allows for clarity in decision making on the part of the patient and their provider. This often results in confusing patient bills, as the amount billed to insurance will vary visit to visit based on the exact services provided that day. Typically, coding for physical therapy services provided (CPT codes), is determined using a complex matrix of "timed codes" and "untimed codes". Think of it as the same way services are rendered for a massage therapist or personal training. You may pay for services using actual cash, a check, or a credit/debit card. The patient pays at the time of service, allowing the therapist to focus attention on providing the best possible service while keeping administrative costs low. In a cash-based treatment model, the physical therapist enters into a contract with the patient to provide physical therapy services in a manner that both parties have determined will help them reach treatment goals most efficiently. ![]()
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