Insurance – Superior Physical Therapy

Cost Information for Physical Therapy

Dear Patient,

It is our goal at Superior 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 Superior.

  • 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 rate of $90 per visit.
  • 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:

If you do not have insurance or have a high deductible policy, please contact Belinda at Phone:
231-421-9277 OR Email: belindas@thesuperiortherapy.com.

Thank you for allowing us to serve you

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” 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.

Below you will find our cost estimator tool which should help you better understand the cost of services at Superior Physical Therapy. This is only an estimate as it is impossible to determine the exact cost due to insurance contract complexity. It is also important to note that we do not control the cost of services, that is determined by your insurance company.

Please also note that the cost of physical therapy at an independent private practice like Superior 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.

Physical Therapy Cost Estimator

PRIORITY HEALTH

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MEDICARE

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Blue Cross Blue Shield

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All Other

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Self Pay

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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