We believe in making your healthcare experience easier by offering the following conveniences.
- Most insurance accepted & filed including Medicare, Medicaid, Blue Cross Blue Shield, Coventry, Midlands Choice, Aetna, United Healthcare, GEHA, Railroad Plans, RCI, Workers' Compensation and many more...
- Insurance verified for benefits and referral requirement
- Accurate and timely insurance and patient billing
- Claim inquiries
- Payment plans, credit cards, private pay
YOU HAVE A CHOICE!
Although your doctor may refer you to a specific PT or facility, you have the choice and the right to see any PT or go to any facility you choose. Nebraska is a "direct access" state; therefore a doctor's referral is not required for physical therapy services. Because of the effectiveness of physical therapy, some choose to pay for physical therapy directly if their insurance policy does not cover the services, their benefits have run out, or if they do not want to obtain a referral that may be required by their insurance.
Most health insurance covers physical therapy, but coverage varies with each plan. In most states you can see a PT without a doctor's referral, but be sure to check your health insurance plan to see if the services of a PT are covered without a referral. If you must see a PT designated by your health care plan, check you plan to determine whether you can see an "out-of-plan" provider by paying a co-pay or a percentage of the cost instead of a co-pay.
For your convenience, we can verify your insurance and check to see if you need a referral!
Video - Understanding Insurance Coverage
We know that the health payment process can be complex and confusing. Here is an excellent video that explains general concepts about insurance coverage.
Below, you will see a list of terms that pertain to insurance coverage and payment for health services.
- Co-insurance: in indemnity, the monetary amount to be paid by the patient, usually expressed as a percentage of charges.
- Co-payment: in managed care, the monetary amount to be paid by the patient, usually expressed in terms of dollars.
- Consumer Driven Health Care (CDHC): refers to health plans in which employees have personal health accounts such as a health savings account, medical savings accounts or flexible spending arrangement from which they pay medical expenses directly.
- Deductible: the portion of medical costs to be paid by the patient before insurance benefits begin, usually expressed in dollars.
- Denial: refusal by insurer to reimburse services that have been rendered; can be for various reasons.
- Eligibility: the process of determining whether a patient qualifies for benefits, based on factors such as enrollment date, pre-existing conditions, valid referrals, etc.
- Exclusions: services that are not covered by a plan.
- Flexible Spending Arrangements (FSAs): an account that allows employees to use pre-tax dollars to pay for qualified medical expenses during the year. FSAs are usually funded through voluntary salary reduction agreements with an employer.
- Gatekeeper: in managed care, it refers to the provider designated as one who directs an individual patient's care. In practical terms, it is the one who refers patients to specialists and/or sub-specialists for care.
- Health Maintenance Organization (HMO): a form of managed care in which you receive your care from participating providers.
- Health Savings Account (HSA): a savings product that serves as an alternative to traditional health insurance. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.
- Managed Care: a method of providing health care, in which the insurer and/or employer (policyholder) maintain some level of control over costs and utilization by various means. Typically refers to HMOs and PPOs.
- Member: a term used to describe a person who is enrolled in an insurance plan; the term is used most frequently in managed care.
- Open Enrollment: a set time of year when you can enroll in health insurance or change from one plan to another without benefit of a qualifying evening.
- Out-of-pocket: money the patient's pays toward the cost of health care services.
- Payer: the party who actually makes payment for services under the insurance coverage policy. In the majority of cases, the payer is the same as the insurer. But, as in the case of very large self-insured employers, the payer is a separate entity under contract to handle the administration of the insurance policy.
- Policyholder: purchaser of an insurance policy; in group health insurance, this is usually the employer who purchases policy coverage for its employees.
- Preferred Provider Organization (PPO): a form of managed care in which the member has more flexibility in choosing physicians and other providers. The member can see both participating and non-participating providers. There is a greater out-of-pocket expense if member sees non-participating providers.
- Premium: the cost of an insurance plan shared by employer and employee.
- Provider: one who delivers health care services within the scope of a professional license.
- Reimbursement: refers to the payment by the patient (first-party) or insurer (third-party), to the health care provider, for services rendered.