YOUR HEALTH. YOUR WAY.

While Direct-pay (fee for service) physical therapy puts you back in control of your health!

How Direct Pay Service Benefits You

Our direct payment system offers you the highest level of care for a flat rate of $120 a session.

Let us explain how this benefits your health, saves you time and can actually save you money:

Under the “standard” medical model, you are treated in blocks of roughly 15 minutes, deemed a “unit.”  Each unit is priced separately. That means that exercise is a unit, hands-on-treatment is a unit, and so on. Typically, each unit is billed at a cost in the $60 range, adding up to $120 per 1/2 hour of care (or $240/hour). This happens everyday in every insurance-pay clinic.

Now this is where it gets really interesting…

Insurance providers use many tactics to pay as little as possible on claims, such as denying charges, insisting charges be re-coded, requesting re-evaluations every few visits, delaying payments and so on. Insurance adjusters (i.e. people who are not your physical therapist) limit the number of times you can be seen by your physical therapist, regardless of how you are progressing.  Known as a “cap” this can be based on a cash-value or a number of visits. They also decide how much your insurance company will actually pay known as “allowable amount” (typically in the 40-60% range of the actual bill). So a 30-minute PT visit might be reimbursed at $70 and a 60-minute session might be between $100-130. Whatever you paid in copay or deductible is subtracted from that amount and the insurance pays the difference.

The claims process described above can take months. To ensure success in this process, your provider needs to hire extra employees to deal with billing, collections, and insurance company run-around. Their internal costs go up while their revenue is capped at what insurance will pay. The result is that your care with a physical therapist is limited (so the clinic can remain profitable and cover their overhead).  With limited one-on-one time with your therapist, you’ll likely need more visits to overcome your injury!

ACRO Physical Therapy & Fitness was founded with the goal of Inspiring Individuality in our clients.  This goal ties in with the belief that top-notch care cannot be rushed, limited or capped. Your quality of life should not be dictated by your insurance company.

Each direct-pay visit is 55 minutes of one-on-one contact with the PT (as opposed to the typical 20-30 minute model). Angie has the time to fully assess your condition(s), provide hands-on treatment, educate you and help you build a plan to get back to your life. Knowledge really is power. By having extended time with each patient, she is able to provide faster results and better outcomes!

If you have insurance that offers out-of-network coverage and want to use it, you can. You pay directly (at the time of service) and we will issue you a receipt (known as a “superbill”) that you can submit to your insurance company. They will then choose the amount to reimburse you. Each plan varies, so you should review your policy specifics, but typically an “out of network provider” is compensated at a percentage of shared cost.  This means that your insurance provider will pay a percentage of the cost and you will be responsible for a percentage.

As every insurance plan is different, we recommend using this checklist of questions to find out more about your specific plan:

TOP 4 QUESTIONS to ask your insurance provider regarding your out-of-network benefits for physical therapy:

1. Do I have out-of-network physical therapy benefits? If not, what does that mean?
2. Am I eligible to receive direct reimbursement from the insurance company for my physical therapy visits?
3. What percentage of the money I paid at my physical therapy visit will you, the insurance company, reimburse me (the patient)?
4. Do I have an out-of-network deductible to meet first?

Even if you have no out of network benefits, or just want to pay with cash and avoid the hassle, the value still benefits you!

The average physical therapy insurance copay is $35/visit (but can range from $25-60/visit).  If you need just 12-16 visits at a standard clinic, you are paying $420-560 out-of-pocket and only getting 4-6 hours of one-on-one time with the PT.  With that model, you are likely also going to PT 2-3 times a week – putting your cost at $70-105/week. Another concern is your time – while PT direct contact time is only 20-30 minutes, you’ll have exercises and modalities (traction/heat/ice) that extend your time in the clinic to 75-90 minutes.  This can add up to 20+ hours of time out of your life for the duration of your recovery!

At ACRO PT, our model gives you more hands-on care and requires fewer total visits.  Rather than 2-3 visits per week to get 55-minutes of time with the therapist, ACRO PT’s 55-minute treatment sessions mean that 1 visit per week is often all that is needed. This puts your out-of-pocket costs at a comparable $120/week. Instead of extending your visit time with exercises in the clinic, you will be given a home program and information to take with you – saving you precious time during your day.  In the end, you’ll get better faster and be back to doing what you love sooner!

REFERRALS

New Jersey is a direct access state, meaning a prescription from your physician, midwife, or other health care provider is not necessary prior to attending physical therapy.

INSURANCE

Lotus Physical Therapy and Wellness, LLC is an “out of network” (OON) provider. This means that you pay upfront for your services and you are responsible for submitting a claim to your insurance. Before you tune out, you should understand a few things.

We would not be able to ensure the unique physical therapy experience we are committed to providing with insurance companies dictating how often, how long, and what you receive in therapy. In a typical PT clinic, it is not uncommon for you to be in therapy 2-3 times a week for 6-8 weeks. You most likely have a co-pay which must be paid at each and every visit. That adds up quickly. If you’re lucky, you will have reached your deductible. If not, you will be paying out of pocket for all those visits.

Other physical therapy providers that accept insurance are forced to see multiple patients within the hour, leaving you to do exercises on your own after only 15-30 minutes with the therapist. The personal experience is lost when your therapist is busy bouncing from patient to patient.

When compared to your deductible, co-pay, and co-insurance, you will end up saving money. At the end of the day, you’ll receive personalized care from a caring physical therapist, save time, and save money.

REIMBURSEMENT

Depending on your insurance, you may be eligible for reimbursement for your OON physical therapy services. Contact your insurance company prior to your first visit to inquire. You will be provided with the necessary documentation needed to submit a claim. Not sure what to ask your insurance provider? Contact us and we will walk you through the right questions to ask