Frequently Asked Questions
Q. Why don't you take my insurance?
A. Insurance companies have very restricted contracts for physical therapy that can often times make reimbursement inconsistent and very poor. Because PACE Physical Therapy holds each client with an utmost value, we want to make sure we can provide the best quality, individualized care at every session. Not being restricted by insurance contracts allows us to provide care beyond comparison to other insurance based clinics.
Although we do not take in-network insurance, we do offer Superbills after every session for you to obtain out-of-network reimbursement. Actual rate of reimbursement depends on your particular plan. In addition, we accept all FSA and HSA cards so that you can utilize the benefits given to you from your health coverage while still receiving superior care. We highly recommend downloading the form below to help you figure out and understand your physical therapy benefits.
A. Insurance companies have very restricted contracts for physical therapy that can often times make reimbursement inconsistent and very poor. Because PACE Physical Therapy holds each client with an utmost value, we want to make sure we can provide the best quality, individualized care at every session. Not being restricted by insurance contracts allows us to provide care beyond comparison to other insurance based clinics.
Although we do not take in-network insurance, we do offer Superbills after every session for you to obtain out-of-network reimbursement. Actual rate of reimbursement depends on your particular plan. In addition, we accept all FSA and HSA cards so that you can utilize the benefits given to you from your health coverage while still receiving superior care. We highly recommend downloading the form below to help you figure out and understand your physical therapy benefits.
| Understanding Your Benefits |
Q. At my last PT place I only had a $35 co-pay. Why do your sessions cost more?
A. The majority of PT clinics are in-network with insurance companies around the nation. Co-pays and co-insurance rates are common practice because the therapists see 2-4 patient each hour (16-32 patients each day) and are able to bill at higher rates/hour compared to seeing one patient/hour. This means that the patient generally sees the therapist for 10-15 minutes before another patient comes in to start therapy, or they are handed off to a tech/assistant to go through the exercise program. In our opinion, this is sub-par care and not in our business model. We don’t feel modalities like ice or hot packs are a good use of time during a PT session. We also don’t want you doing regular exercises during our time that you can easily do on your own at home or the gym. We feel the greatest service we can give to our clients is time and attention. With the recent changes in our healthcare system, many of the patients we were seeing on a weekly basis while we worked in an in-network clinic had co-pays from $50-80 dollars/session. And 2-3 sessions/week was the normal plan of care. That totals $100-240/week or up to $960/month!
In addition, patients that have to meet their deductible prior to receiving therapy benefits are often charged $150-$300 each session from their in-network provider until they meet their deductible. That quickly adds up if you’re attending therapy 2-3 times/week and not actually being billed for 6-8 weeks after the start of care due to a lag in the billing turnaround. Our patients generally only need to be seen 1-2 times/week at most and because they get individualized care the entire time, they are able to get better quicker and for less overall costs.
Q. Do I need a referral from my physician to start physical therapy?
A. No physician referral is needed to get evaluated by a physical therapist. However, in Texas, a referral script is required prior to the start of treatment. This can be obtained from a MD, DO, Chiropractor, Dentist, Podiatrist, NP, or PA anywhere in the country. Do you have a friend or family member in one of these fields? Call them up and they can send over a prescription for treatment!
Q. I have a prescription from my doctor from earlier in the year, will this suffice for current treatment?
A. PT prescriptions are good for the same body part/injury for up to 1 year.
Q. I don’t currently have any injuries, but I would like my running form to be assessed to make sure my technique is correct to prevent future issues. Do I still need to get a PT prescription?
A. If you are asymptomatic, we can happily evaluate you and address your concerns with no prescription. If it turns out that you will benefit from additional PT sessions, we can send over the assessment to your physician and obtain a signed plan of care to continue with treatment as needed.
Q. Do you accept Medicare?
A. We do not have a relationship with Medicare; thus, we cannot treat medicare beneficiaries unless they choose to withhold all billing from their insurance. If you are determined to see us for your therapy, this request must be made up front and signed consent will be obtained. No superbill is given in this case. However, if you feel you’d rather utilize your insurance benefits, we will be happy to discuss other potential physical therapists in the area to meet your needs. We do offer wellness programs for those Medicare beneficiaries trying to take advantage of non-covered services. Please contact us for further details if interested.
A. The majority of PT clinics are in-network with insurance companies around the nation. Co-pays and co-insurance rates are common practice because the therapists see 2-4 patient each hour (16-32 patients each day) and are able to bill at higher rates/hour compared to seeing one patient/hour. This means that the patient generally sees the therapist for 10-15 minutes before another patient comes in to start therapy, or they are handed off to a tech/assistant to go through the exercise program. In our opinion, this is sub-par care and not in our business model. We don’t feel modalities like ice or hot packs are a good use of time during a PT session. We also don’t want you doing regular exercises during our time that you can easily do on your own at home or the gym. We feel the greatest service we can give to our clients is time and attention. With the recent changes in our healthcare system, many of the patients we were seeing on a weekly basis while we worked in an in-network clinic had co-pays from $50-80 dollars/session. And 2-3 sessions/week was the normal plan of care. That totals $100-240/week or up to $960/month!
In addition, patients that have to meet their deductible prior to receiving therapy benefits are often charged $150-$300 each session from their in-network provider until they meet their deductible. That quickly adds up if you’re attending therapy 2-3 times/week and not actually being billed for 6-8 weeks after the start of care due to a lag in the billing turnaround. Our patients generally only need to be seen 1-2 times/week at most and because they get individualized care the entire time, they are able to get better quicker and for less overall costs.
Q. Do I need a referral from my physician to start physical therapy?
A. No physician referral is needed to get evaluated by a physical therapist. However, in Texas, a referral script is required prior to the start of treatment. This can be obtained from a MD, DO, Chiropractor, Dentist, Podiatrist, NP, or PA anywhere in the country. Do you have a friend or family member in one of these fields? Call them up and they can send over a prescription for treatment!
Q. I have a prescription from my doctor from earlier in the year, will this suffice for current treatment?
A. PT prescriptions are good for the same body part/injury for up to 1 year.
Q. I don’t currently have any injuries, but I would like my running form to be assessed to make sure my technique is correct to prevent future issues. Do I still need to get a PT prescription?
A. If you are asymptomatic, we can happily evaluate you and address your concerns with no prescription. If it turns out that you will benefit from additional PT sessions, we can send over the assessment to your physician and obtain a signed plan of care to continue with treatment as needed.
Q. Do you accept Medicare?
A. We do not have a relationship with Medicare; thus, we cannot treat medicare beneficiaries unless they choose to withhold all billing from their insurance. If you are determined to see us for your therapy, this request must be made up front and signed consent will be obtained. No superbill is given in this case. However, if you feel you’d rather utilize your insurance benefits, we will be happy to discuss other potential physical therapists in the area to meet your needs. We do offer wellness programs for those Medicare beneficiaries trying to take advantage of non-covered services. Please contact us for further details if interested.
