The traditional medical business model necessary for “in-network” insurance-based physical therapy practice is not aligned with our values and Mission Statement because it does not support our patient-centered care. When you choose Total Potential, you choose to get the compassion and hands-on care that you deserve.
All treatment sessions are one-on-one with an expert Manual Physical Therapist, and are scheduled for either 1.5 hours, 1 hour, or 30 minutes. The rate for treatment sessions and other services vary, so please call us at (424) 254-9273 to inquire about pricing.
We are a fee-for-service clinic that is not in-network with any insurances. Upon request, receipts can be provided that include the necessary codes to send self-claims to your insurance company.*** Please read below on how the changes in many health insurance plans and deductibles have actually made it Cheaper to Not use your insurance for some services (like PT) if you have high PT copays or a high deductible.
(Excerpts from our FAQ page)Why is insurance not billed at Total Potential? And did you say that can actually save me money?
The short answer:In many ways, insurance companies dictate or strongly influence the treatment that patients receive at “in-network” clinics, and we refuse to allow that to be the case at Total Potential.
The longer answer:
We are an out-of-network practice because the business model necessary for an in-network practice to survive rarely ever allows for the high-level care we insist
on giving our patients.
What the heck does that mean? …
Due to progressively worsening reimbursement rates and pressure from insurance companies, the therapists at in-network clinics have to see at least
2 patients per hour (usually many more) and they often use technicians and assistants to provide much of the actual patient care. The care often includes modalities like heat packs and ultrasound, and the majority of a patient’s time at the clinic is spent doing exercises they could do on their own time. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week.
We do not believe that modalities are nearly as effective as our hands-on treatment, and we also do not agree with having patients pay to perform exercises in the clinic that they can easily perform at home or at a gym.
All of our patients receive one-on-one
care and hands-on treatment from a Doctor of Physical Therapy in every session
. Most sessions are a full hour unless the patient chooses 30 minute sessions. With this long-session, one-on-one treatment approach, the plan of care for the vast majority of our patients only involves one appointment per week.
When you consider the time savings of fewer trips to the clinic and the value of resolving your pain so much faster than average, the out-of-pocket expense at Total Potential is a huge bargain.On top of that, the out-of-pocket expense for our treatment sessions is sometimes less than a patient would pay at a clinic that accepts and bills their insurance.How is that possible?!As deductibles and PT copays have skyrocketed in recent years, many of our patients who have high PT copays or have not met their deductible pay less out of pocket for our treatments than they would if they went to a clinic that “takes their insurance.”
So before deciding on where to get PT based solely on which clinics “take your insurance,” make sure you know how much you’ll be paying at your in-network options versus an out-of-network clinic like ours …
These days, some insurance plans provide zero coverage for PT visits or require copays of over $50/visit. And if you have a deductible to meet, you’ll likely end up paying the full bill for your PT sessions until you meet the deductible (and these bills are often $200+ per session). However, you usually won’t start receiving those $200+ bills until after
you’ve been getting care for 6-8 weeks and have racked up an enormous total balance (again, often being asked to attend PT 2-3 times per week).
And guess what else… just because you’re paying $200+ per session at a clinic that is in-network with your insurance, does not
mean that your insurance is applying that full amount towards your deductible! They often only apply the amount that they have agreed is reasonable for your PT sessions which is, of course, far less
than the amount the PT clinic actually charges.
Most people are quite unaware of the games their insurance companies play in order to pay out as little as possible and maximize their profits. So as you weigh your PT options, it’s very important to:
1. Inquire with your insurance company about what percentage of the total PT bill you will be required to pay at an in-network clinic (especially if you still have a deductible to meet). If you will be paying 100% of the bill till you’ve met your deductible, ask the prospective PT clinic the amount of the average bill sent to an insurance company (the PT clinic’s amount on the bill … NOT what the insurance company has agreed they will pay the clinic). In most cases, you will ultimately be paying the full bill until your deductible is met.
2. If you have met your deductible, ask how much your copays will be? Ask how many times per week the average patient is asked to come in for treatment.
3. Consider the quality of care you’ll be receiving at your various options, and how much value you place on receiving higher-quality, one-on-one care from a Doctor of Physical Therapy rather than a PT Assistant (PTA) or an unskilled “Tech.”
4. Consider how often you’ll be missing work and/or time with family to attend your PT sessions. Again, you can ask any prospective clinic how many times per week their average patient is asked to come in for treatment.
Ask the above questions, do the math, and you may be quite surprised at what you find!
* One other thing to consider is whether or not you have just one deductible or if you have both an in-network deductible and an out-of-network deductible. If you have two deductibles, then claims from an out-of-network clinic like ours will not apply to your in-network deductible.
With all the above information, you can now get a real sense of what your true costs will be, what level of care you’ll be getting, and then make the best decision on where to receive your physical therapy treatment.Can I bill my insurance for reimbursement of my out-of-pocket expenses?
This depends on the insurance you have, but YES, most NON-Medicare patients can send “self-claims” to their insurance company for their treatments at our clinic. We have partnered with Reimbusify to provide a unique service for our patients to submit Out-of-Network (OON) claims in less than a minute. We did this so that you can focus on getting the treatment that you need rather than spending your time and money on submitting self-claims.
In addition, you can click here
to file your claim FREE for this practice.
The amount of reimbursement or application towards your deductible is completely dependent on your insurance plan. If you call your insurance company to inquire about what you can expect to receive, you should ask about reimbursement for “out-of-network Physical Therapy” expenses sent in via self-claims.
Medicare Beneficiaries: The US government has some interesting laws that control where Medicare beneficiaries can spend their healthcare dollar and persuade healthcare providers to enroll in their system. Because we are not
Participating Medicare Providers, we can only accept Medicare beneficiaries as patients when the patient does not
want Medicare billed for any PT services. This request to not involve Medicare in payment must be made up front by the patient and be made of the patient’s own free will.
In other words, if you’re a Medicare beneficiary and are adamant about seeing us for your care even though we are not participating Medicare providers, we can help … However, the only way we can provide you with PT services is when you truly don’t want Medicare involved and you ask up front that Medicare not be billed or involved in your physical therapy care.
If you do
want to use your Medicare benefits for physical therapy, we cannot provide you with treatment at our clinic but we can help you find a good Medicare provider in your area.