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.

Benefits and Eligibility – Things you want to know:

Deductible
  • How much is your deductible and has it been met for the year?
  • Will P.T. visits at Prevail apply to the deductible?
  • NOTE: If your deductible does not apply or has been met, then you are no longer responsible for the “full amount” of each service bill, but only a portion (for most plans).
Visit Limit
  • How many visits do I have per year for physical therapy?
  • How many do I have left?
  • NOTE: Most plans have a visit limit for REHAB visits, which include not only physical therapy but chiropractor visits, massage therapy visits, occupational therapy, etc… Be sure to know what your limits are. Even if you haven’t been to physical therapy, your visit limit could be less than you think or already be used up.
  • Reaching your visit limit: 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
  • Do I have a co-payment amount for each visit? If so, how much?
  • Do I have a co-insurance amount for each visit? If so, what percentage of each bill am I responsible for?
  • NOTE: Co-pays and co-insurance go into effect once the deductible has been met per year. If the deductible has not been yet, you are responsible for the full amount of each bill until it has. Only then do your co-payments or co-insurance plans kick into gear.
Prior Auth, Rx, Referrals
  • Does my plan require any prior authorization, prescriptions, or referrals for Physical therapy (in the network or out of network)?
  • NOTE: If your plan DOES require these things and they are not obtained in the allotted time frame, your insurance will not cover your visits.

In order to understand your benefits, we recommend you give your insurance company a call. Below are some basic prompts you can follow to find out more information about your coverage.

  1. Determine whether or not your insurance is “in-network” with Prevail, or if it is an “out of network” plan. You can call or email us to determine this distinction.
  2. Look on the back of your insurance card and call the number that is associated with the word “Customer” or “Member.”
  3. Follow the prompts and give the necessary information needed in order for the system to pull up your benefits.
  4. Review your eligibility and benefits for Physical Therapy (either in network or out of network).
  5. If the automated message is difficult to understand, you can always ask for a “representative”, “customer service”, or an “agent.” Most insurance companies will then direct you to an employee.
  6. Never be afraid to ask them questions! If you don’t understand your benefits, they are there to help.