Insurance
No one likes unexpected bills, so if you have commercial health insurance, please check with your carrier to determine your coverage. These are the questions you need to ask:
Do you need a referral from your primary care provider (PCP) or specialist?
Do you need pre-approval for physical therapy?
What is your co-pay?
Do you have a deductible?
Is there a limit on the number of physical therapy visits you can have?
Is there a limit on the dollar amount you can spend for physical therapy?
Medicare currently has an annual cap for physical therapy and speech therapy combined of $1900. Once that amount has been reached, the therapist can bill with special codes that certify that additional therapy is medically necessary, so that the cap rises to $3700. After that point any additional visits must be pre-approved.
Vermont Medicaid limits combined physical, occupational and speech therapy visits to 30 per calendar year.
I am a “participating provider” with Medicare, Vermont Medicaid, Blue Cross and Blue Shield of Vermont, MVP and Cigna. If you have one of these insurances, I will submit your bills directly to your insurance carrier. You will receive a bill from my billing service, Preferred Medical Billing of Derry, NH, which will inform you of what your insurance has paid and what you owe for deductibles and co-pays.
For all other commercial insurances, I am currently an “out-of-network” provider. This generally means that your insurance carrier will pay less for me than for an “in-network” therapist, and you will have to pay the difference. In most cases I can submit your bills directly to your insurance carrier. You will receive a bill from my billing service, Preferred Medical Billing of Derry, NH, which will indicate what your insurance has paid and what you owe.
CMI classes are a “wellness activity”, not billable as physical therapy. Your insurance may include coverage for “wellness activities”. In this case, I can provide you with a bill that you can submit for reimbursement.