You don’t need another job. We help take the pain out of insurance. We submit claims on your behalf to maximize reimbursement.
We accept Medicare insurance. All other insurance is accepted as out-of-network. We do not accept Medicaid.
WHY OUT OF NETWORK ? ITS PUTTING YOUR HEALTH FIRST
Most patients utilize our services as an “out-of-network” provider.
We are a specialist care provider that only accepts doctorate therapists that have devoted their professional lives to pelvic physical therapy and a commitment to the highest level of training.
We focus on patient health first and have opted out of jumping through arbitrary insurance restrictions and hoops designed for general physical therapy clinics and assembly line patient volume mills.
We provide flexibility with follow-up treatment times of 45 or 60 minutes to assist with minimizing costs.
We are credentialed with most “out-of-network” health insurance companies. Your claims will be electronically submitted to your out-of-network provider on your behalf – making it hassle-free to utilize your available benefits.
While receiving care out-of-network may not seem ideal ideal on the surface, cutting corners on receiving specialized health care is often penny wise and pound foolish given we frequently get patients back to health faster and with fewer treatment sessions.
We can assist with helping you determine your insurance benefits to make informed decisions about your care.
WANT TO KEEP IT SIMPLE? USE REDUCED CASH PAY
We do our best to keep cash pay rates affordable (effective Feb 18, 2023).
- 45-minute treatment sessions $125
- 60-minute evaluation or treatment sessions $155
Yes – our patients regularly tell us we should charge more as the price is less than a regular massage or fancy haircut.
SELECTING YOUR HEALTHCARE TEAM
Colorado is a “DIRECT ACCESS” state and the vast majority of plans allow you to see a physical therapist directly – without first seeing a physician and needing a prescription.
HMO plans are the exception and require you to have a prescription from your physician in order for outpatient physical therapy services to be covered.
UNDERSTANDING HEALTHCARE COVERAGE
What will this cost with Out-Of-Network benefits?
Total Treatment Cost
Regular 45 Min Session
$130 – $145
Total Treatment Cost is primarily determined by the length of the session and service provided.
Your share of the cost is determined by your insurance plan.
Your explanation of benefits (EOB) may show charges that are higher than the estimated treatment cost noted above. Medical charges stated on the EOB are different than what is allowed by insurance companies.
KEEPING THE COSTS DOWN
The current healthcare crisis, to put it bluntly, is in part due to a complete lack of understanding of how much it costs to deliver patient care. With all faults, the total treatment cost estimate above is our attempt to be clear and provide transparency.
As an “out-patient” clinic we keep the costs down. Some clinics charge ill-informed patients under an “in-patient” setting (typically affiliated with a hospital that could be at a different location), where the total treatment cost to you and/or your health insurance company can be 2 – 3 times higher.
How you and your insurer share costs
Sally’s Insurance Plan Example
Jan 1st – Dec 31st
Before Sally reaches her deductible
Sally is typically in good health.
Her plan doesn’t have a co-pay for physical therapy and she pays any costs until she reaches her deductible
After Sally reaches her deductible
Sally has seen various healthcare professionals and her total costs have exceeded $1,500.
Her plan pays a % of the covered healthcare services until her out-of-pocket-limit. The % split is known as the co-pay.
After Sally reaches her out-of-pocket limit
Sally has seen healthcare professionals often and her total costs have exceeded $5,000.
Her plan pays full cost of covered health care services for the rest of the year.
Treatment Cost = $75
Sally Pays = $75
Plan Pays = $0
Treatment Cost= $75
Sally Pays 20% = $15
Plan Pays 80% = $60
Treatment Cost = $75
Sally Pays 0% = $0
Plan Pays = $75
OUR INSURANCE BILLING PROCESS
COMMON HEALTH INSURANCE TERMS
An in-network provider is a healthcare professional or facility that has a contract with an insurance company to provide treatment at set negotiated rates. We may be an in-network provider with your insurance company (see partners above).
Cash Based Provider
Collect the entire payment from the patient and provide superbill for the patient to submit in order to receive reimbursement. The terms “cash-based provider” and “out-of-network provider” are often used interchangeably. However, out-of-network providers are always credentialed—and therefore recognized by the insurance company.
Prior Authorization or Pre-Certification
Pre-certification is the process of obtaining eligibility, certification and/or authorization from your health insurance plan prior to admission and receiving treatment. Failure to obtain pre-certification from certain providers can result in additional costs to the patient.
The amount you owe for covered services, per policy period, before your health plan begins to pay.
We accept health savings account (HSA) or flexible spending account (FSA) cards as a form of payment, and we are also proud Medicare and Tricare providers.
An out-of-network provider is a healthcare professional or facility that is credentialed with but has no contractual agreement to charge a specific rate with an insurance company. The insurance company recognizes the provider as being a legitimate medical professional—it knows things like the provider’s name, national provider identification (NPI) number, professional license number.
If you have no health insurance plan.
Co-Payment or “Co-Pay”
A fixed amount you pay for a covered health care service, usually when you receive the service. Your co-payment is counted towards the total cost of care.
The most amount of money you will pay during a policy period before your health plan begins to pay 100% of the allowed amount.
Copyright @2023 Pelvic Therapy Specialists, PC. All rights reserved.
Our clinic serves all of the Denver metro area, including: Boulder, Louisville, Superior, Lafayette, Longmont, Arvada, Westminster, Thornton, Brighton, Erie, Frederick, Firestone, North Denver, Northglenn, Broomfield, Golden, Wheat Ridge, Lyons, Lakewood, Dacono, and Commerce City