In a cash-based treatment model, the physical therapist enters into a contract with the patient to provide physical therapy services in a manner that both parties have determined will help them reach treatment goals most efficiently. The patient pays at the time of service, allowing the therapist to focus attention on providing the best possible service while keeping administrative costs low. You may pay for services using actual cash, a check, or a credit/debit card. You may also use FSA/HSA cards. Think of it as the same way services are rendered for a massage therapist or personal training.

Typically, coding for physical therapy services provided (CPT codes), is determined using a complex matrix of "timed codes" and "untimed codes".  This often results in confusing patient bills, as the amount billed to insurance will vary visit to visit based on the exact services provided that day. Cash-based billing eliminates this confusion and allows for clarity in decision making on the part of the patient and the provider. Documentation for evaluations, treatment visits, and progress notes are performed just like any other physical therapy practice and comply with all legal requirements.

This simply means that I have not entered into a contract with individual insurance companies to receive reimbursement based on their contracted rates. There are MANY insurance companies, each with their own contracted rates and regulations, and my energy is best spent working with patients. It is important to note that in-network provider status is not currently based on education, experience, skills, or treatment outcomes, but is often determined by the number of providers in a demographic area.

Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide payment for services received "out-of-network". Going out-of-network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. Many patients choose to receive services out-of-network in order to see the physical therapist of their choice. In the case of cash-based services, it is the patient who is waiting for reimbursement rather than the provider.

The process is actually quite simple: I will provide you with an invoice at the time of service, and you may submit that invoice to your insurance company for reimbursement. The invoice has all of the necessary information (business name and address, tax ID, national provider identification, license numbers, etc.) as well as the patient’s ICD-10 (diagnosis) and CPT (billing) codes.

In many cases, the out-of-pocket expenses for a course of physical therapy will actually be LESS for services provided at Evolution Health & Perfromance. In large part, this is due to the ability to charge less per visit, with these charges being well below the national average charge submitted to insurance in a typical outpatient practice. I can charge less because the simplified cash-based fee structure streamlines billing and does not require hiring billing personnel or paying fees to a third party billing service. This allows me to focus all energy on patient care, and allows patients to make informed decisions regarding the costs of their health care choices.