As PT professionals, we get asked a lot of questions about insurance and coverage. Here are the top questions we are asked along with answers that will hopefully help!

Q&A –

Q: Why did I receive a bill when I paid my co pay at my appointment?  

A: If the member’s insurance plan carries a deductible, the deductible must be paid in full before only the co-pay or co-insurance will cover the PT visit.  

Q: What is a deductible?  

A: The deductible is the amount the member pays out-of-pocket for the services before insurance begins to cover.  Patients will be billed the difference between the co-pay paid at the visit and the contracted rate between the office and the insurance company for services rendered.  

Q: What is the difference between a referral from the Doctor and an insurance referral that is required?

A referral from the Doctor is similar to a prescription stating the diagnosis of the patient. The insurance referral is required from the insurance company in order for the patient’s claims to be paid. Most HMO plans require an insurance referral before the claim will be paid.  Patients are responsible for notifying their PCP to ask for such. 

Q: What is the difference between an HMO and a PPO?

A: HMO stands for Health Maintenance Organization, and the coverage restricts patients to a particular group of physicians called a network. PPO is short for Preferred Provider Organization and allows patients to choose any physician they wish, either inside or outside of their network.

Q: If you do not take my insurance, can I still choose to come to Fitzgerald PT

A: Yes, we want to be accessible to all. However, you will be responsible for payments for your appointments. We charge $185 for the initial evaluation, and $85 for each follow up appt.

Hope that answers many of your questions. Of course, we want to help you feel better soon. We accept most insurance plans, however, we encourage you to review the requirements of your insurance coverage and bring your insurance card or verification with you on your visit to the clinic.

You can always call us with any insurance questions and we’ll be happy to help. Or easily book your appointment online now!