Knowing what your insurance will cover prior to your first appointment gives you peace of mind and helps to prevent any unexpected detours or surprises from happening down the road. But health insurance isn’t always easy to understand, and there are sometimes specific requirements that may or may not be necessary in order for your insurance to cover your visits here at Prevail. Our customer service team is here to help! You can reach us by calling our office at 206-788-8807 or emailing [email protected]. In order to verify your coverage, we will need the name and date of birth of the subscriber on your plan, as well as the member ID number listed on your insurance card.
Listed below are common insurance terms & topics that can assisst you in developing a better understanding of your coverage.
A deductible is the amount of money you are required to pay before your insurance provider begins to contribute.
For Example: With a $2000 deductible, you are responsible for paying the first $2000 of covered services yourself. After you have met your deductible, you usually only pay your copayment or coinsurance for covered services.
Annual insurance limits determine the maximum amount of money an insurance provider will pay towards your healthcare services. Insurance coverage can be limited to a set dollar amount of covered services or to a certain number of visits that will be covered for a particular service. Physical Therapy services are most commonly limited by the number of visits.
Most plans have a visit limit for REHAB visits, which include not only physical therapy but chiropractor visits, massage therapy visits, occupational therapy, etc…
If you’ve reached your limit, your insurance will no longer cover your physical therapy visits and you will be fully responsible for the bill.
Co-pay and Co-Insurance
A copayment is a fixed amount (i.e. $20) that you are responsible for paying towards each visit once you have reached your deductible.
Coinsurance is the percentage of total cost (i.e. 20%) that you are responsible for paying towards each visit once you have reached your deductible. This amount cannot be determined until after your visit and will appear on your monthly billing statement.
Prior Authorizations, Prescriptions, Referrals
In WA state, prescriptions & referrals are not required for Physical Therapy services.
However, some insurance plans may require prior authorizations, prescriptions, or referrals. This gives them a chance to review how necessary physical therapy may be in treating your injury/chronic condition.
The referral process serves as a way for your Primary Care Physician or referring provider to communicate and coordinate care with your Physical Therapist. Sometimes referrals are required by insurance providers as a form of pre-approval so that they can make sure everything is in order in seeking physical therapy treatment.
If your plan DOES require these things and they are not obtained in the allotted time frame, your insurance will not cover your visits.
L&I & MVA
L&I and MVA claim information is required upon scheduling your initial examination. Referrals are also required for this type of coverage.
For L&I & MVA coverage we will need your claim number and date of injury/accident, as well as your case managers name and phone number.
**We do not do third party billing for MVA claims.