SPECTRUM Therapy Billing
SPECTRUM Therapy understands you have a choice in your rehabilitation provider. We're happy you chose our clinic for your rehabilitation needs and hope that you will be pleased with the care you receive here. For this reason, we feel that it is important for you to be informed about our financial policies and for us to respond to your insurance concerns.
After receiving your insurance information, we will attempt to verify your benefits. This is done before your first visit in order to inform you of your coverage. We will let you know the number of visits you are allowed or the monetary amount we can charge, if applicable, on your financial policy.
We will bill your insurance weekly, and, upon receipt of the claim, your insurance company has 30 days to pay or deny the charges. Your charges may be different for each visit. Your insurance company is responsible for sending you, the insured, an Explanation of Benefits, which they also send to us.
SPECTRUM Therapy bills monthly for any charges not covered by insurance or any balance you may owe. We expect prompt payment within 30 days. We will add a finance charge of 1% monthly for any balance over 30 days due by the patient.
Supply Policy
When verifying your insurance benefits, we will ask if Durable Medical Equipment (supplies) is covered under your policy and will inform you of those benefits on your financial policy. If Durable Medical Equipment is not covered, payment for the supply you are receiving is expected at the time it is given to you.
Please do not hesitate to approach the SPECTRUM Therapy office staff with any questions you may have about our fees, charges or financial policies. We are happy to answer your questions and listen to your concerns.
Insurance Information
SPECTRUM Therapy Accepts:
Managed Care Health Insurance
SPECTRUM Therapy is a participating provider with many insurance companies, including Anthem Blue Cross Blue Shield and Southern Health. We accept these companies' allowable charges and you are responsible for all copayments and deductibles. It is important that you, as the patient, and that we, as the provider of service, are aware of any limitations on therapy services. For example, your insurance company may require preauthorization for your visits or a referral from your Primary Care Physician. The carrier may have limitations on the monetary amount we can charge or the number of visits you can have. It is the patient's responsibility to obtain preauthorization from the Primary Care Physician. We gladly accept all offers to become providers with Managed Care Networks in our area. However, there are some networks that are 'closed' to accepting therapy providers and therefore will not allow us to participate with them..
Medicare
You will have benefits for outpatient therapy services under Medicare Part B. Therapy services have to be considered 'medically necessary' for Medicare to process for payment. We will accept assignment for Medicare and we will gladly bill your MediGap (secondary insurance carrier) as well. You are responsible for any deductibles, plus any balance that insurance will not pay. Medicare will pay 80% of the approved charges. Some MediGap policies will cover the remaining 20% and the Medicare deductible.
Private/Commercial Insurance
We will file with your private insurance company weekly. You are responsible for any deductibles as well as any unpaid amount that the insurance company will not cover. Upon each visit, we request a deposit equal to the estimated percentage that your insurance company will not cover. Most Private/Commercial Insurance Companies do not pay for supplies (Durable Medical Equipment).
Self Pay
We have a Self Pay rate for patients that do not have health insurance.
Worker's Compensation
We bill Worker's Compensation Insurance carriers for all services rendered, including supplies.
We will not expect any payment from you unless your Worker's Compensation claim is denied. In that case, we file through your health insurance. If you do not have health insurance, you are responsible for making payment in full.
Personal Injury/Litigation
If you are involved in a personal injury case or accident, it is our policy to file through your health insurance as opposed to your automobile insurance. We will not send the bill directly to your attorney although your attorney may write to us to request a copy of your bill. You may request payment from your automobile insurance from the MedPay portion of your policy. It is SPECTRUM Therapy's policy that we will only allow the balance on your account to accumulate to $1,000 and then we will require payment from you for everything above that amount.
Understanding Your Insurance
Since you (or your employer) are paying the premiums for your insurance coverage, you have a right to know about your benefits. Clearly understanding your insurance policy coverage can help prevent misunderstandings, as well as confusing statements and bills.
Most insurance companies rely on UCR to determine the benefits payable. UCR stands for "Usual, Customary and Reasonable" and refers to the amount they will accept for each charge. Insurance companies set their own UCRs and are required to describe and explain them to you when you open a policy. This is why you may end up with a balance after receiving services, even though your insurance company stated it would pay 100% of "usual, customary and reasonable."
SPECTRUM Therapy would like to be a participating provider with your insurance company. When we become a participating provider with an insurance company, we agree to accept that company's UCR as payment in full, less deductibles or copays. This is beneficial to you, as the patient, because you will not be held responsible for the charges that go beyond the UCR. You are only responsible for the copayment or percentage that your insurance company will not cover.
If you have questions or concerns about what your insurance company considers "Usual, Customary and Reasonable," call their customer service line and ask a representative to explain it
to you. We suggest that you have your insurance company give you your benefits for physical therapy in writing prior to your first visit. If you have any further inquiries regarding your insurance company itself, they should be directed to the Insurance Commission of the state in which you hold your policy.
Your Financial Responsibility
We wish to stress that you, as the patient, are financially responsible for any and all services rendered by SPECTRUM Therapy regardless of your insurance coverage. Our consensual agreement is with you, our patient, not your insurance company. As a service to you, we will bill your insurance company weekly for charges incurred. Any copayment, coinsurance or deductible in your responsibility is due to us at the time of service. If you are receiving services at our clinic more than once a week, we will allow you to pay weekly, but will expect payment at the beginning of the week, rather than at the end. As a convenience to you, we accept cash, checks or credit cards (Visa, Mastercard, American Express and Novus cards.)
Thank you for choosing SPECTRUM Therapy!