Insurance Information

At Paso Robles Physical Therapy we know how confusing and ambiguous health insurance can be. We are dedicated to making insurance clear and understandable in order for patients to know their benefits and coverage. The staff is adept at obtaining authorizations and explaining financial responsibilities. We are always more than happy to take the time to assist patients. Please, if you have any questions please do not hesitate to call the office.

Insurances

We are providers for all major insurances including the following:

Medicare
Medicare Railroads
AARP
Blue Cross
Blue Shield
United Ag
Department of Veteran Affairs
Health Net
Tricare
United Health Care
CenCal
Medishare
Workers Compensation
Auto or Personal Injuries
We do offer a Cash Pay Program

We are NOT providers for HMO's, Cigna, Aetna, United Health Care-CCPN, or AARP Medicare Advantage Plans.

Will my insurance cover physical therapy?
All insurance plans and carriers will vary on coverage for physical therapy. Our staff encourages patients to call their insurance provider and verify their own benefits prior to their treatment. It is vital to find out the yearly deductible, the co-pay, and your maximum out of pocket expenses. You can contact your insurance provider with the contact number that is on the back of your insurance card or you can go to your insurance provider’s website.
Understanding Your Insurance Coverage:
Glossary Terms:

  • Deductible- A deductible is the amount you will pay out of your own pocket before your insurance will begin to pay a portion of your health costs. The amount of a deductible will vary from person to person. Deductibles are typically based on yearly health costs depending on your policy and may include different amounts for families.  It is very important to understand your deductible so you are prepared for any out of pocket costs.
  • Co-payment- This is the set amount your insurance company will require you to pay each date of service you attend treatment. This will vary from policy to policy.
  • Co-Insurance- This is a percentage that your insurance company will require you to pay each date of service you attend treatment. Example- your policy could have an 80%-20% plan. Therefore, this means your insurance will pay 80% of the cost and you are responsible for the remaining 20% each visit.
  • Pre-authorization- Some policies will require that physical therapy has a pre-authorization policy before or on your first date of treatment. It is important to be aware of this for your own knowledge and to inform the front office staff so they can begin the process of obtaining authorization for you.
  • Maximum visits- Some policies will have a set amount of physical therapy visits that are allowed annually per calendar year. If your maximum visits are met during your treatment and you require continued care, cash pay programs are available.
  • In-Network Benefits- This means that we are contracted with your insurance provider. If we are in-network providers, we are bound by our contact to accept their determination of all charges and allowed amounts
  • Out of Network Benefits- These are the benefits that your insurance company will consider if we are not a provider for your insurance or in-contract with them. This means you may be financially responsible for a larger portion of the total costs of treatment.

What if you do not have insurance but need physical therapy?
Our office provides a cash pay program that allows patients to receive physical therapy without insurance. Please call our office to see if you qualify, what our cash pay rate is, and what the requirements are.

Will the front office staff assist me with my insurance?
Our front office staff is more than happy to assist you regarding insurance questions. Upon your first visit with our office we will contact your insurance and obtain your eligibility and benefits. We strongly advise that you directly contact your insurance provider personally and obtain all your insurance information. Please keep in mind that all benefits are quoted from your insurance company and not an authorization and promise for payment. We encourage patients to remember that insurance policies are subject to change and can vary beyond our control.