Understanding Your Benefits

Courtesy Benefit Verification

Once you are scheduled for physical therapy, our front office staff will call your insurance company to verify your outpatient physical therapy benefits. It is your responsibility to provide us with the information below in order for us perform a courtesy benefit verification. If information is incomplete or inaccurate, our policy is to bill you directly for the treatment provided.

  • Name of Insurance Company
  • Member ID or Policy Number
  • Provider Services Contact Information
  • Secondary and/or Tertiary Insurance
  • For Automobile or Worker’s Compensation, Claim Number and Adjustor Information is needed

We are not responsible for any incorrect information your carrier may have provided to us. We encourage you to call Member Services to confirm this information. You can often find the number for Member Services on the back of your insurance card.

Understanding Your Benefit Quote

We aim for transparency and communication regarding the cost of your physical therapy care. We will provide you with a benefit quote at your first visit detailing your benefits for outpatient physical therapy. We make every effort to contact patients with high out of pocket physical therapy benefits prior to the first visit.

Every insurance plan has different coverage for outpatient physical therapy. Here are some tips to help you understand what your benefit quote means. Please contact our front office staff at 617-358-3700 with any other questions you may have.

What is a Deductible?

A deductible is the amount you need to pay out of pocket (at the insurance company’s contracted rate) before insurance payment begins. It can take insurance companies up to three weeks to process a physical therapy visit; therefore, you may not have a balance due for a few weeks. It may be in your best interest to discuss payment strategies with our front office to help you better manage your deductible balance.

What is a Copay?

A copay is the out of pocket amount you will owe at each office visit.

What is Coinsurance?

Coinsurance is the percentage of the visit you are responsible for.

Number of Visits

It is important to know how many physical therapy visits are allowed with your plan per benefit period. Your physical therapy visits can be combined with other rehabilitative services and treatment.

Plan Year

It is important to know the start and end date of your insurance plan especially when it comes to deductible and visit utilization. Most insurance plans operate on the calendar year.

Out of Pocket Maximum

After you reach your out of pocket maximum, your insurance company will cover your medical care in full until your benefit period restarts.

Referral/Authorization Required

Your insurance plan may require an insurance referral or authorization. Please note that this is different from a doctor’s order or prescription. Our office will make several attempts to obtain your referral or authorization. If we have any difficulty, or have not obtained the referral by the time of your visit, we will notify you.

Health Reimbursement Account (HRA) and Health Savings Account (HSA) Information

Before your first appointment, please let us know if you have one of these accounts. It is your responsibility to understand if, and how, your account will reimburse us for your physical therapy. It is important to know this information prior to paying out of pocket for your visits.