Do You Take Insurance?
Yes, but we contract with you, the patient, to provide the best care possible. This is our focus.
We are In-Network with BCBS, Medicare, MTI, UHC, and Medrisk. We accept Tricare as Non-Network.
Out of network insurance carriers will allow you to submit an itemized bill from us to your insurance carrier for out-of-network reimbursement. Please call for details.
We are In-Network with BCBS, Medicare, MTI, UHC, and Medrisk. We accept Tricare as Non-Network.
Out of network insurance carriers will allow you to submit an itemized bill from us to your insurance carrier for out-of-network reimbursement. Please call for details.
*** Please read below on how the changes in many health insurance plans and deductibles have actually made it Cheaper to Not use your insurance for some services (like PT) if you have high PT copays or a high deductible.
Why are You Non-Network for TriCare, and Why is That Better for Me?
Insurance companies strongly influence the treatment a patient receives at an in-network clinic, which can result in patients not being able to receive beneficial services. We refuse to allow that to be what dictates how you are treated at ProFormance Therapy and Wellness.
We contract with you, the patient. Not the insurance company, but you can seek reimbursement for our services.
ProFormance is prefers to operate as a non-network practice because the business model necessary for an in-network practice to survive rarely allows for the high-level care we insist on giving our patients.
What the does that mean? …
Currently, TriCare will only pay 70% of their pre-determined allowable rate to a Network provider. To be able to provide the consistent hands-on care during all treatments, focus on constantly progressing and varying your treatments, not rely on modalities to make you feel better, and provide you with additional support outside of the clinic, ProFormance has to stay non-network.
Please see below for a more detailed description of how patients can be better off working with an out-of-network provider.
We contract with you, the patient. Not the insurance company, but you can seek reimbursement for our services.
ProFormance is prefers to operate as a non-network practice because the business model necessary for an in-network practice to survive rarely allows for the high-level care we insist on giving our patients.
What the does that mean? …
Currently, TriCare will only pay 70% of their pre-determined allowable rate to a Network provider. To be able to provide the consistent hands-on care during all treatments, focus on constantly progressing and varying your treatments, not rely on modalities to make you feel better, and provide you with additional support outside of the clinic, ProFormance has to stay non-network.
Please see below for a more detailed description of how patients can be better off working with an out-of-network provider.
Why is Insurance Not Billed for some Commercial Insurances, and How Does it Save Me Money?
Insurance companies strongly influence the treatment a patient receives at an in-network clinic, which can result in patients not being able to receive beneficial services. We refuse to allow that to be what dictates how you are treated at ProFormance Therapy and Wellness.
We contract with you, the patient. Not the insurance company, but you can seek reimbursement for our services.
ProFormance is prefers to operate as an out-of-network practice because the business model necessary for an in-network practice to survive rarely allows for the high-level care we insist on giving our patients.
What the does that mean? …
Due to progressively worsening reimbursement rates and pressure from insurance companies, therapists at in-network clinics have to see at least 2 patients per hour (usually many more), and they often use technicians and assistants to provide much of the actual patient care. The care often includes the majority of a patient’s time at the clinic is spent doing exercises they could do on their own time, heat packs, and ultrasounds. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week.
We do not believe that modalities are typically nearly as effective as our hands-on treatment, and we also do not agree with having patients pay to perform exercises in the clinic that they can easily perform at home or a gym.
All of our patients receive one-on-one care and hands-on treatment from a Doctor of Physical Therapy in every session. With this long-session, one-on-one treatment approach, the plan of care for the vast majority of our patients only involves one appointment per week.
When you consider the time savings of fewer trips to the clinic and the value of resolving your pain so much faster than average, the out-of-pocket expense at ProFormance Therapy and Wellness is a huge bargain.
On top of that, the out-of-pocket expense for our treatment sessions is sometimes less than a patient would pay at a clinic that accepts and bills their insurance.
How is possible to pay less out of network?!
Since deductibles and PT copays have skyrocketed in recent years, many of our patients have high PT copays or have not met their deductible for the year pay less out of pocket for our treatment than they would if they went to a clinic that "takes their insurance".
Be sure you know how much you’ll be paying at your in-network options versus an out-of-network clinic like ours …
These days, some insurance plans provide zero coverage for PT visits or require copays of over $50/visit. And if you have a deductible to meet, you’ll likely end up paying the full bill for your PT sessions until you meet the deductible (and these bills are often $200+ per session). However, you usually won’t start receiving those $200+ bills until after you’ve been getting care for 6-8 weeks and have racked up an enormous total balance after going to PT 2-3 times per week.
Furthermore, just because you’re paying $200+ per session at a clinic that is in-network with your insurance, does not mean that your insurance is applying that full amount towards your deductible! They often only apply the amount that they have agreed is reasonable for your PT sessions which is, of course, far less than the amount the PT clinic actually charges.
Most people are quite unaware of the games insurance companies play in order to pay out as little as possible and maximize their profits. So as you weigh your PT options, it’s very important to:
See the link below for a worksheet to help guide you in working through your benefits.
* One other thing to consider is whether or not you have just one deductible or if you have both an in-network deductible and an out-of-network deductible. If you have two deductibles, then claims from an out-of-network clinic like ours will not apply to your in-network deductible.
With all the above information, you can now get a real sense of what your true costs will be, what level of care you’ll be getting, and then make the best decision on where to receive your physical therapy treatment.
We contract with you, the patient. Not the insurance company, but you can seek reimbursement for our services.
ProFormance is prefers to operate as an out-of-network practice because the business model necessary for an in-network practice to survive rarely allows for the high-level care we insist on giving our patients.
What the does that mean? …
Due to progressively worsening reimbursement rates and pressure from insurance companies, therapists at in-network clinics have to see at least 2 patients per hour (usually many more), and they often use technicians and assistants to provide much of the actual patient care. The care often includes the majority of a patient’s time at the clinic is spent doing exercises they could do on their own time, heat packs, and ultrasounds. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week.
We do not believe that modalities are typically nearly as effective as our hands-on treatment, and we also do not agree with having patients pay to perform exercises in the clinic that they can easily perform at home or a gym.
All of our patients receive one-on-one care and hands-on treatment from a Doctor of Physical Therapy in every session. With this long-session, one-on-one treatment approach, the plan of care for the vast majority of our patients only involves one appointment per week.
When you consider the time savings of fewer trips to the clinic and the value of resolving your pain so much faster than average, the out-of-pocket expense at ProFormance Therapy and Wellness is a huge bargain.
On top of that, the out-of-pocket expense for our treatment sessions is sometimes less than a patient would pay at a clinic that accepts and bills their insurance.
How is possible to pay less out of network?!
Since deductibles and PT copays have skyrocketed in recent years, many of our patients have high PT copays or have not met their deductible for the year pay less out of pocket for our treatment than they would if they went to a clinic that "takes their insurance".
Be sure you know how much you’ll be paying at your in-network options versus an out-of-network clinic like ours …
These days, some insurance plans provide zero coverage for PT visits or require copays of over $50/visit. And if you have a deductible to meet, you’ll likely end up paying the full bill for your PT sessions until you meet the deductible (and these bills are often $200+ per session). However, you usually won’t start receiving those $200+ bills until after you’ve been getting care for 6-8 weeks and have racked up an enormous total balance after going to PT 2-3 times per week.
Furthermore, just because you’re paying $200+ per session at a clinic that is in-network with your insurance, does not mean that your insurance is applying that full amount towards your deductible! They often only apply the amount that they have agreed is reasonable for your PT sessions which is, of course, far less than the amount the PT clinic actually charges.
Most people are quite unaware of the games insurance companies play in order to pay out as little as possible and maximize their profits. So as you weigh your PT options, it’s very important to:
- Inquire with your insurance company about what percentage of the total PT bill you will be required to pay at an in-network clinic (especially if you still have a deductible to meet). If you will be paying 100% of the bill till you’ve met your deductible, ask the prospective PT clinic the amount of the average bill sent to an insurance company (the PT clinic’s amount on the bill … NOT what the insurance company has agreed they will pay the clinic). In most cases, you will ultimately be paying the full bill until your deductible is met.
- If you have met your deductible, ask how much your copays will be. Ask how many times per week the average patient is asked to come in for treatment.
- Consider the quality of care you’ll be receiving at your various options, and how much value you place on receiving higher-quality, one-on-one care from a Doctor of Physical Therapy rather than a PT Assistant (PTA) or an unskilled “Tech.”
- Consider how often you’ll be missing work and/or time with family to attend your PT sessions. Again, you can ask any prospective clinic how many times per week their average patient is asked to come in for treatment.
See the link below for a worksheet to help guide you in working through your benefits.
* One other thing to consider is whether or not you have just one deductible or if you have both an in-network deductible and an out-of-network deductible. If you have two deductibles, then claims from an out-of-network clinic like ours will not apply to your in-network deductible.
With all the above information, you can now get a real sense of what your true costs will be, what level of care you’ll be getting, and then make the best decision on where to receive your physical therapy treatment.
Can I Bill My Insurance for Reimbursement of My Out-of-Pocket Expenses?
This depends on the insurance you have, but YES, most NON-Medicare patients can send “self-claims” to their insurance company for their treatments at our clinic. You should be able to print claim forms off your insurance company’s website, and send it in with the needed receipts and treatment codes that will be provided upon request at our clinic.
The amount of reimbursement or application towards your deductible is completely dependent on your insurance plan. If you call your insurance company to inquire about what you can expect to receive, you should ask about reimbursement for “out-of-network Physical Therapy” expenses sent in via self-claims. Please download the provided "Insurance Benefits Worksheet" to better understand your financial responsibility.
The amount of reimbursement or application towards your deductible is completely dependent on your insurance plan. If you call your insurance company to inquire about what you can expect to receive, you should ask about reimbursement for “out-of-network Physical Therapy” expenses sent in via self-claims. Please download the provided "Insurance Benefits Worksheet" to better understand your financial responsibility.
| Insurance Benefits Worksheet |
