Billing and Cost FAQ

I have a deductible, what do I have to pay?
Based off of our history with the most common insurance companies we have come up with a ballpark amount that will be applied towards your deductible. We usually like to collect something at each visit and so with that ballpark amount we usually collect on the lower end of that. What this means is that if the amount applied towards the deductible is higher than the amount paid you will receive a statement, if it is lower you will receive a refund check. Unfortunately it varies even within the same insurance company.

I have a coinsurance, what is that and what do I have to pay?
A coinsurance is a percentage of the allowed amount. Just like with the deductible, we use the approximate allowed amount to figure what you may owe. We collect on the lower end of that figure, so what this means is that if the amount applied towards the coninsurance is higher than the amount paid you will receive a statement, if it is lower you will receive a refund check. Unfortunately it varies even within the same insurance company.

I believe I’ve met my deductible, but your memo doesn’t reflect that. What do I do?
We are at the mercy of the information given to us by the benefits department. If there have been claims filed, on your behalf, within the last 2 weeks those claims may not be reflected in the information the benefits department has. If you believe the deductible is met we are happy to collect the coinsurance, or file your claims to see how they process.

My therapy is going to span from one calendar year to another. What does that mean for my benefits?
Most insurance companies run on a calendar year, which means your deductible/out of pocket maximum/visit limits reset to 0 on 1/1/**. This means that if you met your deductible in 2014, you will have to re-meet that deductible in 2015. There are a few exceptions to this, UT’s Blue Cross, for example, runs on a plan year of 9/1 – 8/31. If you are unsure what type of year your plan runs on we suggest contacting the member services department for your insurance company.

I have a high deductible, that I know I won’t meet, can I just pay out of pocket and not file to insurance?
Unfortunately, no. We have contracts with most of the insurance companies offered in this area, therefore we are required to file our claims to your insurance.

My friend came here and they paid a different amount. Why?
Every insurance is different, and within an insurance company different plans can have different benefits. Sometimes even year to year coverage and cost can change.

My claims processed differently than what your benefits memo said they would. Do I still have to pay?
Yes, unfortunately mistakes happen. We do our best to get the most accurate information for each patient, but we are at the mercy of what the benefits departments tell us. Ultimately what the claims department says is what we have to follow. The memo we provide is for informational purposes only, it is not a contract, guarantee of benefits or guarantee of coverage. If you feel the claims processed incorrectly we will certainly contact the claims department to have things double checked. Contact us to request the inquiry.

 

At Tillman Physical Therapy we strive to offer the best therapy and experience we can. If you have any questions or concerns please contact us.