Cost Information for Physical Therapy

Dear Patient,

It is our goal at Pinnacle is to provide as much transparency as possible as it relates to cost of services. Below is a list of items that we believe will help you understand what the costs will be while receiving services at Pinnacle.

• Cost is determined by your insurance policy physical therapy benefit, we do not control costs for our services.

• Allowed Amount: Also known as the “negotiated rate” or “eligible expense” is the amount on your statement from the insurance company that the insurance company decides we will be paid for our services.

• Patient responsibility: On your statement from the insurance company is the amount owed by the patient, determined by your insurance company.

• The average allowed amount for an initial evaluation is between $95—165.00 depending on you plans coverage.

• The average allowed amount for a treatment day is between $75.00 -- $124.00, again depending on your insurance type and rate they decide.

• If you are uninsured OR we are out of network with your insurance company, we offer a self-pay rates and bundles. Please click Here for additional details

• If your benefit has a yearly deductible this amount will be applied to it and you will be responsible until that deductible is met.

• A copay or coinsurance often is applied once a deductible is met.

• Some plans have a copay or a co-ins only benefit and does not apply to a deductible.

Please review your insurance verification form given to you at your initial evaluation. This form has your deductible and copay information on it.

If you still have specific questions you can do any of the following:

• Call our Billing Specialist 208.777.4242

• If you do not have insurance or have a high deductible policy, please contact us at

  Phone: 208.777.4242 OR Email: katie@pinnaclephysicaltherapy.org

Here’s some additional physical therapy insurance and payment information so you understand everything we do

Premium

Here is an example…

You have researched health plans and rates and you have chosen one for $150.00 per month. In order to keep your benefits active, you will need to pay your premium on time every month.

Deductible

Definition

A deductible is a set amount you pay every year toward your medical bills before your insurance company begins paying. This will vary for every insurance plan.

Copay

Definition

Your copayment is a flat fee you pay every time you visit a medical professional or fill a prescription. It is usually a relatively small amount. Copayments do not count toward your deductible.

Procedure Code

Here is an example…

We see you for visit where we work on strengthening. We send the code 97140, that the insurance company reads as Manual Therapy Techniques. They then reimburse us the amount they see fit.

Below are listed the procedure codes that we most commonly use during your sessions at Pinnacle Physical Therapy. They indicate what type of treatment we are providing. Each type of treatment has a unique reimbursement that your insurance company has created. Each code is time dependent and differs based on the type of insurance. For example, Medicare uses a system where in a 40 minute session 3 codes are used. All other insurance companies use an 8 minute time for each code.

Below are the codes and what treatments they stand for…

97140 is “Manual Therapy Techniques” when the therapists uses their hands on your body.

97530 is “Therapeutic Activities” that are generally one-on-one patient contact that include exercises that are multi-joint upright movements.

97112 are “Neuromuscular re-education” that includes things like different exercises to improve balance or posture, activating proprioceptors.

97110 are “Therapeutic Exercise” that includes things like different exercises to improve balance or posture.

97162 | 97163 | 97164 is an evaluation of an injury or issue causing the problem

We offer complimentary insurance benefit checks

Unsure about your insurance benefits? If you contact us with your insurance information we will directly contact your insurance provider on your behalf, then provide you all of the details.

Insurances we accept:

We accept nearly all major insurances including but not limited to:

• Blue Cross, Regence Blue Shield

• Medicare, Medicaid and All Medicare Replacement plans

• Aetna

• Kaiser Permanente

• Mountain Health Co-op

• Tri-care

• VA

• Worker’s Compensation (All states including SIF and Washington L&I)

• Health Savings Account (HSA)

• Flexible Spending Account (FSA)

Is your insurance not listed here? Contact us to see if we accept your insurance, the list is always growing!

Don’t have insurance? No problem!

We also have excellent self-pay bundles that can save you a bundle! Check out this PDF for details. We also accept:

• Care Credit…….. Which offers flexible repayment options at little to no interest. This can be a great way to get you a discounted self pay bundle of PT visits.

  Ask our Patient Care Coordinator or Accounts Manager  to help determine if CareCredit is a good fit for you.

  
  We also offer payment options utilizing: Health Savings Accounts (HSA). and Flexible Spending Account (FSA)

  
  We take all forms of payment including:

• Cash, Check, or Credit Card (Visa, Mastercard, Amex, and Discover)

• Have more questions? Contact our billing department at 208.777.4242 and we’ll be happy to assist you.

  * Please also note that the cost of physical therapy at an independent private practice like Pinnacle Physical Therapy on average is 2-3 times less expensive compared to health systems according to a study conducted by the former Center for Studying Health System Change and Published by the National Institute for Health Care Reform.