All sessions at Restore Your Core PT are one-on-one with a Doctor of Physical Therapy who specializes in treating women and men with urinary and bowel dysfunction, complex pelvic pain cases, sexual dysfunction, low back pain, and prenatal and postpartum issues. The rates for evaluations and treatment sessions vary, so please call our office 1-317-559-2673 to inquire about pricing.
We are a fee-for-service practice and are not in-network with any insurance companies which allows us to provide a much higher quality of care delivered in less time. We are considered an out-of-network provider. Receipts are provided to all clients who request them. The receipts include all necessary billing codes to allow our clients to send claims to their insurance companies.
***Please read below to gain a better understanding of why going out-of-network often makes it much cheaper to not use your in-network insurance benefits for some services, including PT, if you have a high deductible plan or high copays.
Why is insurance not billed at Restore Your Core Physical Therapy?
Unfortunately, insurance companies strongly suggest or dictate the length of therapy sessions and the types of treatments that patients can receive at in-network physical therapy clinics. Restore Your Core is an out-of-network provider because we are dedicated to providing the very best care possible without compromising the high level of care we deliver. We believe in order to provide the very best care possible, our patients deserve full-length sessions to address both external and internal causes of dysfunction and pain.
Due to shrinking reimbursement rates and increasing pressure from insurance companies, the physical therapists at in-network clinics are forced to see 2-3 patients every 30-45 minutes. Therapists are also forced to utilize therapy aides to assist patients with exercise and application of modalities, which increases the billable rate. A vast majority of the time, these clinics also require patients to be seen 2-3x per week.
We feel that hands-on treatment is much more effective than utilizing several modalities; furthermore, we do not believe in having patients complete exercises in the clinic that they can do on their own at home. We do not employ therapy aides as we feel every patient deserves to receive one-on-one care from a Doctor of Physical Therapy. We typically see all new patients for a full 90-minute evaluation with 50-minutes follow up sessions. The 50-minute long sessions, combined with one-on-one care, usually allows patients to be seen just once per week. This saves our patients time and money.
How can being seen at an out-of-network facility save you money?
The out-of-pocket expenses you incur at Restore Your Core are often less than what patients would pay at a clinic that bills and accepts their insurance.Due to increasing deductibles and copays, patients who pay out-of-network rates usually pay less than they would if they were in-network.
How is that possible??
If you have a deductible to meet, you will most likely pay the full bill for each PT session until you reach your deductible (these bills can be $350-$700 per session depending on location). However, you won’t receive those bills until you have been getting care for 6-8 weeks and have amassed an enormous balance. Unfortunately, even if you are paying $350-$700 per session at an in-network clinic, that does not mean your insurance company is applying the full amount toward your deductible. Your insurance company typically only applies the amount that they deem as reasonable, which generally is far less than the amount you pay.
Our goal is to make you aware of the games the insurance companies play in order to pay as little as possible, thus maximizing their profits. In order to weigh your PT options, it’s essential to:
- Ask your insurance company what percentage of the total bill will be your responsibility to pay at an in-network physical therapy clinic, especially if you have a deductible to meet. If you are responsible for the total bill until you reach your deductible, ask the in-network clinic what their typical charge is for a physical therapy evaluation and for a follow-up treatment session (not the agreed-upon insurance adjusted rate).
- If you have met your deductible, ask if you have a copay and the amount of the copay that will be due each session.
- Ask if you have an in-network deductible as well as an out-of-network deductible. If you have two deductibles, then claims from Restore Your Core will not apply to your in-network deductible.
Now consider these things when deciding to go to an in-network clinic:
- Ask the in-network clinic how many times per week the average patient is seen.
- Ask if they utilize therapy aides/techs.
- Ask how many patients they see in one hour.
- Ask if you will see one physical therapist for your entire plan of care.
- Ask how much additional training the therapist has in the area of women’s and men’s pelvic health. Physical therapists do not learn the skills needed to treat pelvic and abdominal issues in physical therapy school. It takes several years of continuing education to gain the necessary knowledge to provide patients with excellent quality care
- Ask if the therapist has a certification in pelvic health or if they are being mentored by a credentialed physical therapist in preparation to take the certification test. Certification requires extensive testing. Therapists who have sat for the examination will have the designated credentials of PRPC or WCS if they have taken and passed a certification test.
Consider the quality of care you will be receiving at the in-network and out-of-network facilities. What is the actual value of receiving one-on-one care from a Doctor of Physical Therapy versus that of an unskilled therapy aide/tech? Take the time to consider how much time you will be spending away from your family or your job if the in-network clinic recommends seeing you 2-3x per week. Also, consider the amount of time you will be seen each session. Taking into account all of the above-mentioned items will help you make an informed decision about where to receive your physical therapy treatment.
Can I submit my physical therapy receipts to my insurance company to obtain reimbursement for my out-of-pocket expenses?
Most non-Medicare patients can self-submit their therapy receipts to their insurance company for reimbursement. You should be able to print claim forms from your insurance company’s website and submit it along with your therapy receipts.
Medicare Beneficiaries: The US government has particular and interesting laws that control where Medicare beneficiaries are able to spend their money. Restore Your Core is not a participating Medicare provider; therefore, we can only accept Medicare beneficiaries who do not want Medicare billed for any physical therapy services. This request must be made by the patient upfront and of the patient’s own free will. This means that if you are adamant about seeing the therapists at Restore Your Core, fully understanding that we are not an enrolled Medicare provider, we can still see you if you request upfront that you do not want Medicare billed or involved in your physical therapy care. If you do want to use your Medicare benefits, we will gladly refer you to a Medicare provider in your area.