Billing and Insurance Frequently Asked Questions
Q: Do I need a prescription/referral for physical therapy?
A: This can be confusing because there are 2 parts to this question:
Insurance: Some insurance policies require a signed prescription from your healthcare provider and some do not. We/you would need to call your insurance company to see if this is a requirement.
Physical Therapy Practice Act: By law in Illinois, PTs can treat clients without a signed prescription or Plan of Care (POC) for up to 21 days. If your treatment extends beyond these 21 days, we need a signature acknowledging a POC from your healthcare provider (MD, DDS, DC, DO, NP, PA). This is why we will ask for your healthcare provider’s information when you call.
Q: Does CARE take insurance?
A: CARE is in-network providers for:
BCBS PPO
Medicare
United Health Care PPO
Aetna PPO
We do not accept Cigna.
Q: What if CARE is out-of-network?
A: As a courtesy, CARE will verify your insurance benefits before your first appointment. We will help you understand the cost difference between your out-of-network benefits (deductible and co-insurance) and the possible options of using our self-pay rates.
Q. What are my options if I do not have insurance, or my policy does not provide PT benefits?
A: CARE offers self-pay/cash for service rates:
60 Minutes 45 minutes
Initial evaluation: $190 $160
Follow-up Treatment: $150 $120
Q: How do you bill patients who are self-pay?
A: You have a few options:
You can leave your credit card on file to be charged at the time of service.
You can pay at the time of service (check or card).
If your appointment falls outside of front office hours, you can call in with your information or you will receive a statement at the end of the month.
Q: How do you bill patients who are using their insurance benefits?
A: If your insurance includes a copay, this amount is due at the time of service.
Following each appointment, your therapist will submit charges to be processed by your insurance company. Once this claim has been processed, you and CARE will both receive an Explanation of Benefits (EOB) which outlines your deductible cost, discounted rates, insurance responsibility, and your personal responsibility (deductible and/or co-insurance)
Q: How do I pay my bill?
A: If you have a card on file, typically, CARE sends out statements for your responsibilityevery 14 days via text and email. You will have 5 days to review the statement before your card is automatically charged the balance. If you do not have a card on file, statements will be sent out via text and Email and link and options to pay will be listed on the link
Q: Were my visits submitted to the insurance?
A: Yes! If you provided us with your insurance card at the time of your initial appointment, all visits are being billed to your insurance on file. Please login to your insurance portal or review your Explanation of Benefits from the insurance for information on why we may be billing you for your visit. You can also reach out to the customer service number located on the back of your card.
Q: Why are there 2 lines with the same Date of Service?
A: This is NOT a duplicate! Each line represents
What was done at the appointment
The length of the appointment
Q: I thought my visit was covered by insurance?
A: We verified at the beginning of treatment that Physical Therapy is an approved service benefit under your Insurance Plan. All visits are submitted to your insurance; HOWEVER, you must meet your yearly deductible before the insurance begins to pay any portion of the visit.
Q: Why am I receiving a bill now for a visit I had ____ ago?
A: Normally your insurance will process a claim in less than 30 days. If the insurance has requested additional information or originally denied your claim, this can contribute to a delay in processing your claim, sometimes up to 2 years.
Appeals, reconsiderations, and medical reviews take a minimum of 3 months to process.
Q: How much does a visit cost?
A: If you are using insurance, we can only give you an estimate per visit because each policy has different discounts. In addition, your first visit is higher because of the evaluation. These rates are if you have not met deductible
The ESTIMATED cost is:
60 Minutes 45 minutes
Initial evaluation: $250 $200
Follow-up Treatment: $150 $130
Remember, you still need to meet your deductible before insurance pays anything.