Insurance
In California, physical therapists have direct access to treat patients who have been given a physician’s diagnosis. Most insurance plans include physical therapy benefits. Many insurance companies require a physician’s referral to deem treatment is medically necessary and thus payable under the insurance plan. We accept most insurance plans, and we are preferred providers (PPO) for more than 50 plans in the Silicon Valley including:
- Aetna
- Anthem Blue Cross
- Blue Shield of California
- Medicare
- Valley Health
We are Medicare providers and accept most Worker’s Compensation plans. If we are not listed as a provider in your insurance booklet, please call our office, as the booklet may not be current and we are continually joining new plans. In addition, many insurance plans offer out of network benefits so that you may have access to any provider. We will directly bill your insurance carrier for your treatment.
Insurance plans vary from employer to employer, even when provided by the same carrier. If you have specific questions about your insurance plan, please call (408) 257-6708. Please have your insurance card available so that we may assist you.
INSURANCE TERMINOLOGY
When you schedule an initial Physical Therapy appointment at BEST PT (and you wish to bill your treatments through your insurance) our administrators will work to verify your insurance benefits. Here are explanations of three important insurance terms that represent the portion of the medical bill that you are responsible for.
Deductible – A deductible is usually a fixed dollar amount that you have to pay out of your own pocket before the insurance will cover the remaining eligible expenses. Depending on the insurance plan, the deductible can range from $0 all the way up to thousands of dollars. It can also be paid per sickness/injury (per condition) or per certificate period.
Coinsurance – Coinsurance is usually a percentage, and represents the percentage cost that you will need to pay and the insurance plan will pay towards your eligible medical expenses. Some common coinsurance examples include: 80/20, 90/10 and 50/50 – so if you have 80/20 coinsurance on your insurance plan, it means that the insurance company will cover 80% of your medical cost and you are responsible for paying the other 20% yourself. A deductible is commonly used together with coinsurance. In this case, you would pay the deductible amount first and then you would have the leftover coinsurance amount.
Copay (copayment) – Copays are similar to deductibles, in that it is usually a fixed amount of money you have to pay each time you need to use your insurance plan. Unlike deductibles, copays tend to be smaller dollar amounts and are applied on a per-visit basis so that you would have to pay it each visit. At BEST, your copay will be collected prior to every session.
DIRECT ACCESS
BEST PT accepts patients without a physician referral. In the state of California, patients are able to be evaluated and treated by licensed physical therapists without a physician referral. This means you no longer have to wait to get treated for injuries that would immediately benefit from physical therapy services and this allows patients to expedite treatment while saving money. Expedited treatment time helps reduce total injury time and allows you return to normal function faster. It also saves you from having a costly doctor visit for a prescription prior to a physical therapy visit.
For self-pay patients and some insurances, you do not need a physician referral to come to BEST PT for treatment. However, certain insurances may require a physician referral in order to cover your PT visits. Call our office and our administrator will determine your benefits under direct access and be happy to verify coverage with your insurance company.
