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Insurance FAQs

Q: Do you accept Medicare? Please contact us regarding Medicare eligibility as we will soon start accepting Medicare Part B. We are Cash based for all other insurances.

Q: What is Cash-Based Physical Therapy? In a cash-based physical therapy practice model, the physical therapist enters into a contract with the patient to provide physical therapy services based on patient preferences and goals. This starts a therapeutic relationship between the physical therapist and the client. The patient makes a payment at the time of the service. Payment can be made by cash, check,credit/debit card as well as FSA/HSA cards. This is similar to paying a massage therapist, personal trainer or chiropractor for their services.

Q: What will I need to submit for reimbursement to my insurance company? You will need a Superbill to submit a claim to your insurance company for reimbursement

Q: What are the benefits of a Cash based practice model? 1. Makes the patient committed and willing to invest time and effort in the therapy sessions. 2. Patients who are willing to take the step to pay out of pocket at time of the session are motivated to recover and get results. 3. Therapists spend less time on paperwork because they are not responsible for submitting the claim to the insurance company. Less time spent on paperwork means more time focusing on treating patients, targeting on what matters the most to the patient and staying engaged with them.

Q: Congruence Physical Therapy & Wellness is an out of network physical therapy provider, what does that mean? As discussed above , with a cash based practice model , we have no contract with insurance companies. Typically when contracted /in-network with an insurance company , the practice has to accept reimbursement based on the rates determined by the companies. These rates are not based on therapist expertise, speciality or experience. They also create a false need to differentiate care based on reimbursement amounts. In addition these contracts place more paperwork burden on the therapists. So by walking away from these insurance contracts you get to choose your provider and we can provide more value, time and a uniform model of quality patient care. Cash based practice involves the typical documentation for evaluations, treatment visits, and progress notes just like any other physical therapy practice and comply with all legal requirements.

​Q: Is there a way for the insurance company to cover for these out of pocket /out of network services? Perhaps it is likely they could. Your insurance company could reimburse you for the services we provide. To assist with that, Congruence Physical Therapy & Wellness can provide you with a Superbill to help submit your claim. It is the patient’s responsibility to provide payment at the time of service and then submit the superbill to the insurance company for reimbursement . So it will be the patient who is waiting for reimbursement rather than the provider. Disclaimer: Congruence Physical Therapy & Wellness will provide the required paperwork but will not be involved in the reimbursement process. Insurance companies reimburse patients based on their out-of-network benefits but there is no guarantee. So we suggest you understand the terms and conditions of the reimbursement eligibility and process through your insurance provider prior to the start of our therapeutic relationship.

Q: What is a superbill? A superbill is a document that contains all of the necessary information for an insurance company to decide whether or not they want to reimburse for health expenses incurred by the patient. This is similar to the claims that the physical therapy clinic submits to the insurance company on behalf of the patient for the services delivered. However, a superbill is submitted to the insurance by the patient , instead of the clinic. So now the insurance company pays the patient not the clinic/practice. With a superbill the insurance company assumes that the patient has already paid and the payment that they will provide will be a reimbursement. The Superbill has all of the necessary information (business name and address, tax ID, national provider identification, license numbers, etc.) as well as the patient’s ICD-10 (diagnosis) and CPT (billing) codes.

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