Why is it that intelligent adults, like you and I, and other high functioning responsible folks, are confounded and frazzled by all matters "Insurance?" Probably because they use a counterintuitive language the insurance industry created without any clear translation available. I kid you not. We've been in this medical business fighting to get our paychecks from the insurance companies for 30 years. We pledge to support you with claims reports and will advocate for you to receive your deserved reimbursement from the insurance company that should be serving you, also.
You are not alone if you have been expecting insurance to reimburse you for expenses for medical services you have paid up front for, only to find the money never arrives in your mailbox from your insurance company. You may be left feeling cheated by the insurance system. They frequently send a letter and blame some seemingly random reason that you'll never comprehend. And, oh, by the way. There's no recourse. Too bad, so sad. What other business can a customer receive a service and then have the price the pay out of pocket change after the fact?
You DO NOT need permission from a doctor, or anyone else to come to physical therapy! California is a Direct access state, and does not require an MD prescription. No Rx is required to attend PT, but we’re always interested in seeing one if you have it. A referral serves a valuable role as communication between the physician and your PT. This is helpful information, but not necessary, as we have excellent evaluation skills and capacities. So text, email or bring it with you if you do have a prescription or referral from your doctor. We will happily connect with your MD and can provide them reports about your ongoing PT recovery journey. We can fax an initial evaluation and progress reports to any of your doctors, upon request. For an optimal recovery it's important to have ongoing communication between all of your caregivers. A health & wellness team, working together, can provide you an integrated medicine approach which science has shown to result in complete healing and recovery.
In network health care is a volume driven business. It is a well kept secret how little the PT gets paid once they agree to accept low In network contract rates. That means that your provider, PT or otherwise, receives a fraction of the payment they bill for. If we calculate that per visit payment we see $50-80 paid, in total, for a $275 bill. From the combination of your copay, say $10-20, and a contracted rate payment directly from the insurance company, averaging $40-60. Getting paid only 18-29% of appropriate charges forces busy PT clinics to schedule their PT’s to see up to 3 patients hourly for 8 hours. How could any clinician bring their best self to 24 patients in 24 twenty minute treatments, per DAY, scheduled back to back? That’s just not viable. Seriously. Ask a PT that works in an outpatient PT clinic about the treatment and documentation demands. Honestly, many PTs are now earning phD degrees. Such a lot of learning to be reduced to an over educated work horse with a waining spirit and dwindling vitality. So sorry to go down that rabbit hole, but it’s not right.
Every clinician desires and should have a healing oasis to work in, but most don’t. Do not despair, we do here at Perfect Balance. (Sorry to brag, not really sorry to brag!) Come check out the unique healing enclave that is Perfect Balance Physical Therapy. It’s quiet, serene, free from distraction and full of clinical tools for full recovery and optimal healing. As a bonus, you get to actually know your PT, Christine, who genuinely cares about you. Yes, she will care about you, just as she does EVERY patient she has the honor of treating. You two will have the time and space to finally figure out how to heal. Let’s do this!
Why is the cost of care so mysterious and the answers so elusive regarding how much insurance will cover for your medical costs? Have you ever noticed insurance representatives often are unable to commit to a dollar amount that they will send you after you have already paid for Physical Therapy costs at time of service? It’s not rocket science here. It’s pretty clear cut with PT, as we use a consistent coding system to charge the insurance company same amount ($275) for EVERY all inclusive treatment and ($300) for EVERY evaluation. Even with that predictability, the insurance companies have gotten away with reserving the right not to pay the full percentage dollar amount back to you, the patient, after you’ve paid for the entire amount billed. Why is this allowed and not monitored? We’ve all been there. You’ve already paid in the office on the day of your visit and counted on getting paid a policy specific amount back from your insurance company. It seems to be common insurance business practice to reduce the amount that you will receive back from them for unknown reasons. These reimbursement rates are literally based on rockbottom Medicare prices and are inadequate.
This is how the insurance billing process seems to typically go. After the insurance company computer receives the claim/bill from the provider or the insured submits it, it will be electronically scrutinized to identify possible reasons for denial. Many of us give up on a cumbersome and purposely difficult protocol, become apathetic or just plain don’t know how to get the insurance company to pay the fair and just amount. This is not an accident that they make it difficulty for you to advocate for quality care. Case managers and Adjustors never commit to pay a set amount and often vary payments for the same services on different dates, despite the same bill amount. Have you noticed when you get information online or by phone they will always provide a disclaimer that it is not a guarantee of payment. Well, why not? Every other industry can quote you a price per service. The insurance companies get to slide their payment scale, seemingly randomly. That’s just weird, but we are at the mercy of the insurers so we have to work together. You, the valued patient, and us your caregivers, need to coordinate to get your bills appropriately paid by your insurance carrier.
We HAD to leave in network contracts. We cannot maintain our high standards of care if we sign In Network contracts with insurance companies. In Network PT Clinics are forced to juggle high volumes of patients between Physical Therapists from visit to visit to accommodate busy schedules, precluding consistency of treaters. PTs are fun people that you will want get to know and to have ample time and communication with. Trust us, your PTs care about you. The busy pass around the patient practice decreases the patient & clinician bond. Improved outcomes are seen with establishment of this important relationship. This is why Perfect Balance Physical Therapy left ALL in network contracts AND Medicare. The in network contracts pitiful reimbursement amounts (18-29% of billed amount) are offensive and preclude excellent clinical care. So, there ya have it. Perfect Balance Physical Therapy will remain an Out Of Network Provider so that we can provide YOU excellent high quality clinical services. You’ll get nothing less from Christine Doblar Farfan, a CA licensed PT, for your entire treatment, every visit. Every clinician should have a healing oasis to work in, but most don’t. But, we do here at Perfect Balance. Sorry to brag, not really! Come check out the unique healing enclave that is Perfect Balance Physical Therapy. It’s quiet, serene, free from distraction for full recovery and optimal healing. As a bonus, you get to actually know your PT, Christine, who genuinely cares about you. Yes, she will care about you, just as she does EVERY patient she has the honor of treating. You two will have the time and space to finally figure out how to heal. Let’s do this!
At Perfect Balance PT you get more bang for the buck in every way. The customized one on one treatment style is able to deliver a very comprehensive and full treatment, which decreases the amount of visits necessary significantly, saving you time, money and frustration with slow healing progress. Be assured that all of the advanced high tech & state of the art modalities, biofeedback, specialized equipment or advanced manual techniques that are offered at Perfect Balance PT are available to you at no additional cost. Your treatments are tailored around a clinical model with the full attention of your PT, every time. We do not employ support clinical staff, which is why we are an out of network specialty service. The volume driven model of the in network clinics does not allow us adequate time to provide you a full and effective treatment or the therapeutic space to help you heal. We believe you will notice extreme benefits with a customized Perfect Balance Program. Please know that you’ve chosen the path of quality treatment without constraints by choosing out of network care. You deserve the best customized care available. Come to Perfect Balance PT.
Is there any hope to get reimbursed properly, you ask? Of course, worry not. We have your back here at Perfect Balance PT. This isn’t our first time around the sun. Christine has run PT business’ since the early 1990’s and Perfect Balance PT has been in business since 2007. We know the ropes of the challenging medical industry. We will support you and provide documentation to help you get reimbursed the maximal amount from your Insurance carrier. Our state of the art advanced Electronic Medical Record and Billing System processes all claims nightly. This affords for faster processing of your visit claim and quicker reimbursement to you. Insurance carrier typical time to expect a check is 30-45 days from visit processing date. After 30 years in this business, it seem to us that insurance companies scour claims for loopholes to evade their responsibility pay you back appropriately. After all, YOU the customer pays them a monthly premium.We can help you sort it all out at Perfect Balance PT.
For Clients Using Insurance:
Cost of Initial Evaluation With Treatment: $300
Cost of Customized Treatment: $275
**You may be reimbursed directly by your insurance company up to $225. The exact amount is determined by your policy.**
For Clients Not Using Insurance:
Cost of Initial Evaluation With Treatment: $275
Cost of Customized Treatment: $250
**There will be no direct insurance billing or SuperBills/Claims provided with self pay clients.**
We do take Worker’s Compensation cases, pending specific authorization to attend PT at Perfect Balance Physical Therapy. Ask your worker’s Comp assigned MD to request authorization to come here for your PT. It is your right to request the care of choice. We are happy to coordinate with the MD office to facilitate the referral and authorization process.