Rates & Insurance
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 your friends choose Total Potential, they choose to get the compassion and hands-on care that they 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 their insurance company.
*** Please read below on how the changes in many health insurance plans and deductibles have actually made it Cheaper to Not use their insurance for some services (like PT) if they had 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 because their labor costs less than the licensed provider. 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 because in-network insurance reimburses more for therapeutic exercise. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week. Whatever the insurance will reimburse for, the more that the in-network insurance clinic is incentivized to do more of that instead. This is not necessarily what will actually help your friends get the care that they want.
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 (DPT) 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, perhaps every other week instead.
When your friends consider the time savings of fewer trips to the clinic and the value of resolving their pain so much faster than average, the out-of-pocket expense at Total Potential is a huge bargain.
We also try to create professional relationships with other providers and services where we will not be trapped in being incentivized to continue that professional relationship for only as long as it helps your friends and our patients/clients instead.
Our product is the result. And we strive to structure our way of giving care to deliver on our product.
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 friends' insurance,” make sure they know how much they’ll be paying at their 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 your friends have a deductible to meet, they’ll likely end up paying the full bill for their PT sessions until they meet the deductible (and these bills are often $200+ per session). However, your friends usually won’t start receiving those $200+ bills until after they’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 your friends are paying $200+ per session at a clinic that is in-network with their insurance, does not mean that their insurance is applying that full amount towards their deductible! They often only apply the amount that they have agreed is reasonable for your friends' 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 your friends weigh they're PT options, it’s very important to:
1. Inquire with your friends' insurance company about what percentage of the total PT bill they will be required to pay at an in-network clinic (especially if they still have a deductible to meet). If your friends will be paying 100% of the bill till they’ve met their 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, they will ultimately be paying the full bill until their deductible is met.
2. If your friends have met their deductible, ask how much their 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 your friends will be receiving at their various options, and how much value they 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 your friends will be missing work and/or time with family to attend their PT sessions. Again, they 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 your friends may be quite surprised at what they find!
* One other thing to consider is whether or not your friends have just one deductible or if they have both an in-network deductible and an out-of-network deductible. If they have two deductibles, then claims from an out-of-network clinic like ours will not apply to their in-network deductible.
With all the above information, your friends can now get a real sense of what their true costs will be, what level of care they’ll be getting, and then make the best decision on where to receive their physical therapy treatment.
Can I bill my insurance for reimbursement of my out-of-pocket expenses?
This depends on the insurance your friends have, but YES, most NON-Medicare patients can send “self-claims” to their insurance company for their treatments at our clinic. As a service to you, we have partnered with Reimburisfy so that you can quickly check your Verification of Benefits. To do so, you can click here.
The amount of reimbursement or application towards your friends' deductible is completely dependent on their insurance plan. If they call their insurance company to inquire about what they can expect to receive, they 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 your friends' Medicare beneficiary and are adamant about seeing us for their care even though we are not participating Medicare providers, we can help … However, the only way we can provide them with PT services is when thety truly don’t want Medicare involved and they ask up front that Medicare not be billed or involved in their physical therapy care.
If your friends do want to use their Medicare benefits for physical therapy, we cannot provide them with treatment at our clinic but we can help them find a good Medicare provider in their area.
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 their insurance company.
*** Please read below on how the changes in many health insurance plans and deductibles have actually made it Cheaper to Not use their insurance for some services (like PT) if they had 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 because their labor costs less than the licensed provider. 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 because in-network insurance reimburses more for therapeutic exercise. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week. Whatever the insurance will reimburse for, the more that the in-network insurance clinic is incentivized to do more of that instead. This is not necessarily what will actually help your friends get the care that they want.
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 (DPT) 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, perhaps every other week instead.
When your friends consider the time savings of fewer trips to the clinic and the value of resolving their pain so much faster than average, the out-of-pocket expense at Total Potential is a huge bargain.
We also try to create professional relationships with other providers and services where we will not be trapped in being incentivized to continue that professional relationship for only as long as it helps your friends and our patients/clients instead.
Our product is the result. And we strive to structure our way of giving care to deliver on our product.
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 friends' insurance,” make sure they know how much they’ll be paying at their 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 your friends have a deductible to meet, they’ll likely end up paying the full bill for their PT sessions until they meet the deductible (and these bills are often $200+ per session). However, your friends usually won’t start receiving those $200+ bills until after they’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 your friends are paying $200+ per session at a clinic that is in-network with their insurance, does not mean that their insurance is applying that full amount towards their deductible! They often only apply the amount that they have agreed is reasonable for your friends' 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 your friends weigh they're PT options, it’s very important to:
1. Inquire with your friends' insurance company about what percentage of the total PT bill they will be required to pay at an in-network clinic (especially if they still have a deductible to meet). If your friends will be paying 100% of the bill till they’ve met their 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, they will ultimately be paying the full bill until their deductible is met.
2. If your friends have met their deductible, ask how much their 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 your friends will be receiving at their various options, and how much value they 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 your friends will be missing work and/or time with family to attend their PT sessions. Again, they 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 your friends may be quite surprised at what they find!
* One other thing to consider is whether or not your friends have just one deductible or if they have both an in-network deductible and an out-of-network deductible. If they have two deductibles, then claims from an out-of-network clinic like ours will not apply to their in-network deductible.
With all the above information, your friends can now get a real sense of what their true costs will be, what level of care they’ll be getting, and then make the best decision on where to receive their physical therapy treatment.
Can I bill my insurance for reimbursement of my out-of-pocket expenses?
This depends on the insurance your friends have, but YES, most NON-Medicare patients can send “self-claims” to their insurance company for their treatments at our clinic. As a service to you, we have partnered with Reimburisfy so that you can quickly check your Verification of Benefits. To do so, you can click here.
The amount of reimbursement or application towards your friends' deductible is completely dependent on their insurance plan. If they call their insurance company to inquire about what they can expect to receive, they 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 your friends' Medicare beneficiary and are adamant about seeing us for their care even though we are not participating Medicare providers, we can help … However, the only way we can provide them with PT services is when thety truly don’t want Medicare involved and they ask up front that Medicare not be billed or involved in their physical therapy care.
If your friends do want to use their Medicare benefits for physical therapy, we cannot provide them with treatment at our clinic but we can help them find a good Medicare provider in their area.
Choose an option below to get started.