Your primary insurance will be billed as a courtesy to you. Co-pays are due at time of service unless other arrangements have been made with the office. Upon beginning therapy, all effort will be employed to verify insurance benefits as an additional courtesy. While we commit to taking all reasonable action to provide accurate benefit information for your specific plan, be aware that verification of benefits is not a guarantee of payment from your insurance carrier. Patient is responsible for understanding personal coverage benefits and limitations. Patient is accountable for all charges incurred during treatment after 90 days if not covered by insurance.

The VA will be billed as a courtesy to you. Co-pays are due at time of service unless other arrangements have been made with the office. Upon beginning therapy, all effort will be employed to verify insurance benefits as an additional courtesy. While we commit to taking all reasonable action to provide accurate benefit information for your specific plan, be aware that verification of benefits is not a guarantee of payment from your insurance carrier. Patient is responsible for understanding personal coverage benefits and limitations. Patient is accountable for all charges incurred during treatment after 90 days if not covered by insurance.

For your convenience we will bill Medicare for you. In most cases, Medicare will pay 80% of allowable charges when “medical necessity” requirements are met. Medicare or our office will bill your secondary insurance. If no secondary insurance is provided, the 20% balance will be billed to you. Please read below for additional information.

Please pay balance in full at time of service. Refunds and retro billing are not available.

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Disclaimer to Self-Pay Patients

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Federal law, under the No Surprise Act, requires health care facilities provide an estimate of total cost of services to patients who do not have insurance or are paying cash for treatment. This Good Faith Estimate shows the costs of services that are reasonably expected for your health care needs for Physical Therapy. The estimate is based on the information known at the time the estimate was created. This estimate is based on an average of 8 treatment sessions. Please note that your individual treatment may require less than 8 appointments, reducing the cost. Patient will only be charged for prior arranged and accepted scheduled appointments. Good Faith Estimate is for $755 -1 evaluation appointment at $125 + 7 follow-up appointments at $90/each. If only 3 appointments are required patient will be charged $305 -1 evaluation and 2 standard appointments, etc.

The Good Faith Estimates does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens (this is not expected here at Progressive Physical Therapy), federal law allows you to dispute (appeal) the bill. At Progressive Physical Therapy you may accumulate additional charges ONLY if further appointments are required for optimal treatment, or a rare circumstance requiring you receive an evaluation appointment rather than a standard visit- due to complex status change or a new region of injury discovery. Patient is responsible for scheduling additional appointments; appointments and cost will not be incurred without patient knowledge and acceptance.

This Good Faith Estimate is not a contract and does not require the patient to obtain the services from any of the providers or facility identified with in. Treatment may be discontinued at any time by either the patient or rendering Physical Therapist. If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. You may contact the health care provider or facility (Progressive Physical Therapy) listed to let them know the billed charges are higher than the Good Faith Estimate. You may ask them to update the bill to match the estimate, ask to negotiate the bill, or ask if there is financial assistance available. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

A valid claim/case number, adjuster contact, and billing address must be provided in order for your Worker’s Compensation carrier to be billed for your treatment. Per contract, all attendance records will be forwarded to claims adjuster. Please note patient will remain financially responsible for all charges if carrier denies coverage for any reason.

A written statement from a legitimate insurance company containing the insurance company’s name, address and phone, injury date, claim number, and billing information must be presented prior to initial service. Insurance company will be billed for all services provided to you. In the event insurance denies payment, patient will be responsible for all charges incurred during treatment.