Frequently Asked Questions

In-network providers have agreed to accept a discounted rate for providing their service in exchange for being listed as a preferred provider by an insurance network. This carries serious ramifications for how services can be supplied to the consumer. One result involves decreased time with the provider. Providers are forced into carrying a high volume case-load with the help of assistants and aides to keep the business open. In-network providers are subject to what seems like annual percentage decreases in payment which does not make sense in a world where inflation has been consistently on the rise. To add insult to injury, there are networks that constantly change billing rules, thus forcing therapists to spend their time and energy on keeping-up with the ever changing regulations rather than on actual patient care. One way insurance companies drive how the patient is treated is by assigning a lower dollar value on select billing codes to discourage their use. This is not considered an “evidenced based practice” but effectively undermines the therapist by devaluing their clinical judgment. In-network reimbursement rates make it impossible to balance running a profitable practice while still providing quality patient care.

When a provider moves Out-of-Network (OON), they are choosing to take third-party groups out of the equation when it comes to making treatment decisions for their patients. They believe that these decisions should remain strictly between the patient and the provider. Complex problems are best handled in a low patient to therapist ratio environment. One-on-one care is foundational for building the most effective and efficient treatment program to meet the patient’s needs. At Revive and Thrive, we believe that providing quality care is non-negotiable.

In the cash-based treatment model, the physical therapist enters into a contract directly with the patient instead of the insurance company to provide physical therapy services in a manner in which both parties have agreed upon will assist the patient in reaching their goals of care. The patient pays at the time of service, allowing the physical therapist to focus attention on providing the best possible care instead of keeping up with the constantly changing payment landscape that insurance companies drive.

Documentation for evaluations, treatment visits, and progress notes are performed just like any other in-network physical therapy practice and comply with all legal requirements.

Most insurance companies, with the exception of Medicare, Medicaid, and some HMO’s, will provide payment for services received “out-of-network”. Going out-of-network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. Many patients choose to receive services out-of-network in order to see the physical therapist of their choice. The end goal of documentation and billing remains the same: getting paid. In the case of cash-based services, it is the patient who is waiting for reimbursement rather than the provider.

Since this is a cash-based, OON (out-of-network) clinic, you do not need to have insurance to be seen.

Evaluations are $325 for 75 minutes

Subsequent treatment sessions are $250 for 60 minutes

At first glance the cost seems steep. However, take a moment to break this down assuming that your most valuable time in the clinic is time spent with the actual therapist who evaluated you and wrote your treatment plan. In many cases, the overall number of visits required to gain relief will be fewer in an environment that allows for 100% of treatment time to be directed exclusively by your physical therapist.

Your time is important. For every minute you spend in a physical therapy appointment, wouldn’t you like to know that each of those minutes is being used as efficiently as possible through direct care by a physical therapist who is focused on your goals?

You may pay for services using actual cash, check, credit or debit card, including those from FSA/HSA/HRA type accounts. Payment is due at the time of service.

Consider doing the following:

• Call the customer service phone number on the back of your insurance card.
• Ask, “I would like to work with an out-of-network outpatient physical therapy provider. How much can I expect to be reimbursed?”
• Then ask, “What is the best way to submit a claim for reimbursement using a superbill?”
• Be sure that your insurance plan benefits are clear to you. Which services does your plan cover? Which services count toward your deductible?
• It’s always a good idea to keep a log for any encounters you may have with your insurance provider. Write down the date and time the call was made, who you spoke with, what information was provided. This way, you have a record you can refer to if problems arise.

To make this process easier for you, a worksheet has been created for your convenience. You can download and print it from here.

Keep in mind: should you opt to submit a superbill, you are releasing your personal medical information which is protected by law. This means that you are waiving some of your rights to privacy and confidentiality. It is standard practice for your insurance company to maintain a record of your diagnosis noted on the superbill as part of your permanent medical file.

Revive and Thrive Physical Therapy and Wellness does not have a relationship with Medicare and does not bill Medicare. Thus, if a Medicare beneficiary needs services that Medicare covers, regulations prevent our physical therapist from providing those services to the beneficiary. This legal prohibition applies even if the individual is willing to pay out-of-pocket for care. However, we can provide services to Medicare beneficiaries who wish to self-pay if Medicare does not cover those services. For example, we can provide services that the federal government categorizes as “wellness” or “preventive care.” Similarly, we can sometimes work with Medicare beneficiaries who have been discharged from covered physical therapy services after reaching their goals of care. In such cases, we typically help individuals move towards personal goals that exceed the level of function necessary for daily living.

Physical therapy is a direct access profession in the state of California. This means that a patient may initiate care under a physical therapist without a doctor’s referral. If your insurance is covering all or a percentage of your physical therapy visits, you may receive treatment without a signed plan of care from your physician for up to 45 calendar days or 12 visits, whichever comes first. If your course of care extends past this timeframe, a signed plan of care is necessary.

If you are seeking wellness, preventative, or movement optimization type services, signed plans of care or prescriptions from your doctor are not necessary.

Bear in mind, not all insurance plans are created equal – some still require a referral/prescription from a doctor or other referral source (Physician’s Assistant, Nurse Practitioner, Podiatrist, Dentist, etc.). It is the patient’s responsibility to confirm what documentation is required by their insurance company if they intend to submit a claim to their insurance for services provided.

It is never a bad idea to see your doctor before initiation of care to ensure that this is the best path for you to take. Patient care is at its best when a team approach is used. Communication is maintained with your referring physician or the physician you indicate on your intake paperwork through sending the evaluation and progress reports to them.

This insurance benefits worksheet was created for your use to assist you when calling your insurance company to determine whether or not you require a doctor’s prescription and can also help to walk you through understanding your specific plan benefits as they pertain to physical therapy services.

Whether this is your first injury, your 7th injury, or you’ve been desperately searching for a way to escape chronic pain, Revive and Thrive was inspired by and created for the many frustrated individuals who have felt pushed to the side by the current healthcare system. We welcome the complex cases and those who have “failed” using the traditional model.

We also welcome those who are doing “ok” but want a way to optimize how they move. Out of a desire to create a shift in how physical therapists are utilized, wellness services are offered here to provide a way to prevent injury instead of simply offer solutions after they happen.

Hint: It doesn’t have anything to do with supplements.

Wellness services are designed to identify your specific movement goals and help you achieve them through using the Three Pillar Approach by optimizing the mechanical capacity, neuromuscular function, and motor control of your system to achieve a more efficient state of mobility. Take a look at our wellness service offerings under the “About” tab. Your options are open-ended and can be tailored specifically for you. Send any questions our way if you are looking for something specific that you don’t see listed.

Physical therapy is intended to address a condition that requires intervention that is medically necessary to allow an individual to function through their daily life. Insurance companies typically authorize treatments that move a patient back to their level of function that was just prior to the incident, thus justifying care under a physical therapist. At Revive and Thrive, we ask the question, “Is is not possible to achieve a level of function that is better than just immediately prior to an injury or chronic pain exacerbation?” We say with a hearty “yes!” we can deliver better than that in most circumstances, and think that you will be pleasantly surprised in what our wellness services can offer you!

It’s whatever you want to make of it. If you want to come in for a movement check-up once or twice a year that’s good. If you want to get in quarterly, that’s great. Once a month, even better! It just depends on how quickly you want to move your system towards a level of greater efficiency. The choice is yours.

Start with sending us an e-mail using one of the links under “contact us” or call the office to request an appointment. Please bear in mind that this is a very small business as response time may not always be immediate. Current patient care is always the first priority.

Dress comfortably in clothes that allow easy access for your therapist to examine and treat your problem areas. Loose-fitting clothes that are comfortable for gentle exercise are always a good choice.

Your time is valuable. It is expected that all paperwork is completed and signed prior to your arrival so that the time may be used for actual examination, discussion of goals, and initiation of care. Examination will involve posture and gait observation along with motion screening and special tests to determine treatment strategy. Questions will be geared toward clarifying exactly where your pain is, what the quality of that pain is, what type of pattern it follows throughout the day (or night), what type of activities provoke it, or what makes it better, etc. Other questions will be geared toward your specific activity tolerance levels to establish a starting point and so that progress toward your goals can be quantified throughout the duration of care. Further questioning digs into what exactly YOUR goals are to have both parties on the same page.

Appointments are 75 minutes for the initial evaluation and 60 minutes for subsequent treatment sessions. Back-to-back appointments may be requested at the time of booking your appointment, especially if you are traveling from out of town to make the most of your drive time. Keep in mind that insurance companies do not typically reimburse for double-bookings. This is simply a courtesy that we offer for your convenience.

Soreness can be a normal response to the examination and treatment process. Although the utmost care is taken to avoid inflicting soreness, it can at times be an inevitable part of the process. When released, long-held restrictions in the tissues of the body can cause soreness and even cause other previously asymptomatic regions to surface as a “new” pain. This is to be expected, especially within the population that deals with chronic pain. Good communication with your therapist during treatment will help minimize any discomfort during and after your visit.

There is no cookie cutter answer to this question as each individual is different with their own unique stories. Most patients begin to appreciate relief after one session. Some individuals with more complicated histories involving multiple body regions giving them trouble may take a few more sessions to begin noticing positive changes. In the instance where relief is not being gained as would be expected, it is customary to refer the patient back to their medical provider to determine whether a different avenue should be explored.