Insurance and Billing
Frequently Asked Questions
Rigby Physical Therapy understands how insurance and medical billing can be a confusing and frustrating process. We have compiled a list of commonly asked questions by our patients and have answered them for your convenience.
What are the financial responsibilities as a patient?
As a patient, ultimately it is your responsibility to know and understand your insurance plan benefits along with any deductible, coinsurance, and/or copayment amounts you may be liable to pay. Additionally, some services and procedures may not be covered under your benefits plan. If your insurance policy does not cover a service or procedure, you may be responsible for full payment of the bill.
We recommend contacting your insurance company’s customer or member service department to find out what your plan covers and what your financial obligations may be. This number can be found on the back of your insurance card.
How do we determine charges?
Our charges are calculated based upon the contracts we have with the many different insurance companies. Each insurance company we are contracted with provides us with a fee schedule. The fee schedule is a list of procedures and services and the amount the insurance company will pay for each. The amount that each insurance company is willing to pay is called the allowed amount. The allowed amounts vary from carrier to carrier. Some will pay more, some will pay less.
We have analyzed each contract and have created a charge which accommodates each insurance company’s allowed amounts. To do this, the service charge may be a small percentage higher than what your insurance agrees to pay us as the provider (a small percentage above the insurance company’s allowed amount). However, ultimately your insurance company establishes the maximum payment for the given service.
What happens if the charges are more than what the insurance company will allow?
If we are contracted with the insurance company, we cannot bill you the difference between what we charge and what the carrier allows. The difference is removed from your account in the form of a contractual adjustment.
If we are not contracted with the insurance company, we will accept payment from the insurance carrier and the patient will be held responsible for the remainder. We will not take a contractual adjustment.
Why do we collect deductible, co-insurance, and/or co-payment amounts at the time of service?
We collect at the time of service to avoid sending a statement to your home after the visit. It also helps us reduce our costs and saves you the trouble of mailing a payment back to us.
How do we calculate what you owe at the time of service?
During the first contact you make to our office, the receptionist will ask for your insurance information. This allows us to contact your insurance carrier prior to your first visit to verify coverage and benefits. We will obtain benefits based on whether your policy is in-network or out-of-network.
What happens if the insurance company processes your claim and leaves you responsible for more or less than you paid at the time of service? Why might you receive a bill after you paid at the time of service?
Our receptionists do their best to provide an exact estimate of the amount you will be left responsible for after the insurance company has processed the claim. However, there are some situations that cause miscalculations.
For example, your insurance company may indicate to us that your deductible hasn’t been met. Meanwhile, another physician’s claim is processing which will cause you to meet your individual or family deductible. Our claim is processed after the deductible has been met. This may cause an overpayment and you will receive a refund from our office.
There are also situations when we may not collect enough. Our office may discover that you were not charged at check-out for a service and/or co-payment. The charge is added and billed to the insurance company. Because the charge was added after check out, the insurance company may leave you responsible for more than what was quoted in the office and you will be billed the difference.
We strongly suggest that you compare the amount you paid while in our office to the amount left towards patient’s responsibility on the explanation of benefits (EOB) sent to you by your insurance carrier. Often your statement balance is the difference between what you have already paid and what the insurance company actually left you responsible for.
Why do some office visits cost more than others?
Office visits are broken down into several different units. The more units billed, the more the insurance will reimburse which, in turn, increases the office visit fee.
There are a number of variables that go into the costs of each visit. Each treatment we provide comes with a code, and each code comes with a charge. Each charge is contracted out with your insurance at a set rate of what they will pay.
Depending on what we do each visit and what your cost will be will vary as you move through your rehabilitation. As you progress and move on to different therapeutic interventions, different codes will be billed and this, in turn, will reflect on your bill.
If there is ever a discrepancy or concern with your bill, you are always more than welcome to discuss this with our billing personnel.
What if I'm not insured or have a high deductible?
No worries. We accept multiple interest free payment plans through CareCredit if you are currently not insured or need help paying off a high deductible. For more complete details about CareCredit, visit their website or give us a call today. We are happy to help you get started in the application process.
Rigby Physical Therapy
3854 East 300 North
Rigby, ID 83442
Fax: (208) 228-0312