Your Personal Best Physical Therapy

In-Network Insurances I Billing Procedure I Billing FAQ

Common Billing Questions:
How do I read my physical therapy statement?

When you receive your bill, you may notice that you have more than one charge for a particular date of service. This is because physical therapy is billed in what is known as "units". Units are a measurement of time, based on Medicare standards for each modality or service a therapist provides. Modalities are types of treatments that may include therapeutic exercise, joint mobilization/MFR, manual traction, e-stimulation, or others. Normally visits will be 3-4 units. Your therapist will determine the unit number based on your particular treatment.

Some insurance plans have limitations on the number of units that may be charged on the same day. Others may have limitations on the dollar amount of services a patient can receive within their course of treatment. Always be aware of the terms of your insurance policy as we are not a party to your individual contract.

How do I pay my bill?

We accept cash, checks, and credit cards (MasterCard and Visa only). If you have any questions regard your bill, please call our dedicated insurance department at 512.329.6617.

How can I understand my insurance benefits better?

Your physical therapy benefits may be different than a regular office copay. While we call on patient's benefits as a courtesy, we encourage all our patients to confirm their benefits themselves and understand them clearly. Below are some helpful insurance terms.

Deductible is the amount of money you must pay each year to cover your medical care expenses before your insurance policy starts paying. For example, if you have a $200 deductible, you must pay $200 before your insurance will cover any expenses. Our appointments usually run about $100 per visit as you are working towards their deductible.
Copay is a flat fee an individual pays for health-care services and the insurance company will pay the rest.
Office Visit Copay is a copay some plans require on your first physical therapy appointment.
Coinsurance is the percentage amount you are required to pay for medical care once your deductible is satisfied. For example, if the insurance company pays 80% of the claim, you pay 20%. This would transfer into about $20 per visit with us.
Out-of-Pocket is the most money you will be required to pay a year for deductibles and coinsurance. Once this is met, the insurance most likely will cover the client 100%.
Benefit Maximum is the most a health insurance policy
will pay for a covered service. This benefit is usually expressed in a dollar or number of visits amount, and may be combined with Speech and Occupational Therapy.
Referrals are required by certain insurance plans before beginning therapy and can be obtained by your PCP (Primary Care Physician). Referrals will authorize you a certain number of visits in a specific time range. A common insurance plan that requires referrals is Blue Cross Blue Shield Health Select.
Pre-authorizations are required by certain insurance plans before beginning therapy and are obtained by calling the insurance company. Once obtained, you are given permission to begin therapy through your health insurance.

Does Your Personal Best file secondary insurance?

We do not file secondary insurances unless your primary insurance is Medicare.

Does my insurance require a referral or a pre-authorization?

The most common insurances that require a referral in advance are:

BCBS Health Select (Group 38000)
BCBS HMO Blue (Group Number ends with an "N")
Tricare Prime
Workers Compensation

Upon calling for your benefits, we will verify if your insurance plan requires a referral or a pre-authorization, and then can help you to obtain one. We are not able to see patients until they have their referral or pre-authorization.

What are Medicare's physical therapy benefits?

Medicare has an annual cap/ limitation of $1810 per year for physical therapy and speech therapy combined. However, there may be exceptions with certain diagnosis codes and selective surgeries. Depending on your charges incurred, Medicare usually allows $100 per visit, which translates to about 18 visits per year.

Each member is required to satisfy a $135 annual deductible. Then Medicare will pay 80% of the allowed charges and you will be responsible for a 20% coinsurance, which usually translates to about $20 per visit. If you have a secondary insurance, we will be happy to file your claims for the remaining balance. Your secondary insurance determines how much, if any, your remaining portion will be.

At your first visit, we will ask you to fill out and sign an ABN (Advanced Beneficiary Notice), an explanation of Medicare benefits and therapy cap limitations.

What is the process for Workers Compensation?

When scheduling your first physical therapy appointment, the Patient Care Coordinator will ask you for:

the date of injury or surgery
workers comp adjuster and contact information
employer and contact information
claim number
pre-authorization fax number (if available)
claims address (if available)
doctor referral and any related medical notes
copy of your insurance card (in case any claims are denied)

Pre-authorization is not required for the first six visits following an examination only when the treatments are rendered within the first two weeks following the date of injury or surgical interventions previously approved by the insurance carrier.

Otherwise, any visits beyond the initial physical therapy appointment require a pre-authorization. Once we have all the information listed above, we will compile a pre-authorization request and fax it to the insurance carrier. By law, they must reply with a response within 72 hours. If approved, they will allow you a certain number of visits during a specified time period to attend physical therapy.

Do you accept automobile insurance?

Yes, but we require a LOP (Letter of Protection) before seeing any patients filing under a vehicle accident. The Patient Care Coordinator will ask you for:

Date of Accident
Insurance Carrier Name
Adjuster Name and Contact Information
Claim Number
Copy of your Health Insurance (in case insurance fails to pay)

Further Questions:

Please view "Billing Procedures " for more helpful information. Also, please call or email us for any further questions.