Insurance – Superior Physical Therapy

Cost and Insurance Info

We strive for transparency at Superior Physical Therapy even though the current healthcare environment admittedly makes it very difficult to provide. On this page you will find information that helps you understand the cost of your treatment. We have listed helpful definitions with example scenarios, treatment codes that we use, and finally the 3 major insurance companies reimbursement for our services. Most people don’t realize that we do not control the cost of our services, the insurance companies do. In addition to this page of information we also provide courtesy service to all patients called an insurance verification. The insurance verification includes our billing specialist contacting your insurance provider which allows us to find out if we are in network, if you have a deducible or copay. We then write this information down and present it to you on your first or second visit for signature and understanding. We hope that all of these processes provide you with the most transparent as possible experience at Superior Physical Therapy. If you have more questions than this page can answer please reach out directly to our billing specialist 231.421.9277 where you can discuss your question on the phone or set up a one on one time to discuss.

Thank you for allowing us to serve you,

Andrew Gorecki
Owner of Superior Physical Therapy

Ever wonder about all the cost of health care? Here are some quick definitions and examples.

PREMIUM

A premium is the amount charged by insurance providers for coverage. Typically, this is paid monthly. You must pay your premium to remain covered by the insurance provider.

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

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.

Here is an example….

Your plan has a $1000 deductible. That means you will be required to pay your own medical bills up to $1000 for the year. Your insurance coverage will begin after the deductible is met. At the beginning of each year your deductible will reset.

COINSURANCE

Coinsurance is the percentage of your medical bill that you share with your insurance company after you have met your deductible.

Here is an example….

If you have an “80/20” plan, this means if your medical bill is $100 your insurance provider will pay $80 and you will be required to pay $20. Coinsurance is different and separate from any copayment.

COPAYMENT OR COPAY

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.

Here is an example….

You have plan that has a $20 copayment for Physical Therapy treatment. This means you must pay $20 each time you visit a Physical Therapy clinic. Copayments are different and separate from coinsurance.

Procedure Code

A procedure code is the medical code that we send to the insurance company to receive reimbursement for your visit.

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.

Allowed Amount

An allowed amount is the amount an insurance company will pay us for different Procedure Codes that we bill to them.

Here is an example….

You have Blue Cross Blue Shield insurance and we bill them for the code 97140, which is $90.00 worth of Manual Therapy Techniques. BCBS then tells us they will only pay $28.06 for that time.

Below are listed the procedure codes that we most commonly use during your sessions at Superior 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. Priority health is not code dependent and is a flat rate per visit.

Below are the codes and what treatments they stand for…

97140
is “Manual Therapy Techniques” like stretches that increase range of motion
97530
is “Therapeutic Activities” that are generally one-on-one patient contact that include exercises to increase strength.
97112
are “Therapeutic Procedures” that includes things like different exercises to improve balance or posture.
97110
are “Therapeutic Procedures” 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.

Now that you’ve got some of the lingo down, listed below are the top two insurance providers and the procedure codes we send to the providers. Also, listed is the amount of each procedure code that is charged to the insurance provider and the amount the insurance company actually pays us.

In the following charts you will find three columns, column one has the procedure code we use which dictates the treatment type during the time period you were with the therapist, column two is the amount we charged the insurance company (not the amount you owe or that we get paid), and column three is the amount that we get paid (allowed amount). We charge the insurance company more than they pay us because there are over 150 insurance companies we work with and the payment ranges significantly, however we can only submit one charge to all 150 companies.

Priority Health

  • Is a flat Reimbursement the first visit (evaluation visit) 90 + 75 = $165.00
  • All visit after that ia not an evaluation is a flat $75.00 per visit
  • Allows $90.00 for all evaluations and $75.00 per day for treatment

Medicare

Procedure Code Charged Allowed Amount
97160 $150.00 $78.03
97161 $150.00 $78.03
97162 $150.00 $79.62
97163 $150.00 $79.62
97164 $75.00 $53.50
97110 $90.00 $24.29
97112 $90.00 $33.04
97140 $90.00 $22.55
97530 $65.00 $33.97

BCBS

Procedure Code Charged Allowed Amount
97161 $150.00 $76.15
97162 $150.00 $79.62
97163 $150.00 $79.62
97164 $75.00 $51.77
97110 $75.00 $53.50
97112 $90.00 $30.39
97112 $90.00 $31.73
97140 $90.00 $28.06
97530 $65.00 $32.73

Helpful hints…

  • The higher your deductible the lower your premium.
  • Certain insurance companies have a Physical Therapy visit limit.
  • Physical Therapy is normally a COMBINED benefit with Chiropractic and Speech Therapy.
  • If you are enrolled in home healthcare your insurance will not pay for out patient Physical Therapy treatment until you are discharged.

Contact Us

Office Hours:
7am - 7pm Monday to Friday

Superior Physical Therapy (West)
3899 West Front St.,
Traverse City, MI 49684
phone: 231.944.6541
fax: 18662055924

Superior Physical Therapy & Spine Center (Central)
722 Munson Ave, Traverse City, MI 49686
phone: 231.421.9300
fax: 231.346.6079

Superior Billing Office
3899 West Front St., Traverse City, MI 49686
phone: 231.421.9277
fax: 231.346.6117