Physical Therapy Benefits
Physical therapy is a covered medical benefit under insurance plans for medically necessary treatment. We are preferred providers for most Insurance plans that service our area including: Medicare, Blue Cross/Blue Shield, Harvard-Pilgrim, Tufts, BMC, GIC, Unicare, Tri-Care, and many others. As a courtesy to you, we are happy to verify physical therapy benefits prior to your first visit.
Billing and Insurance Claims
As a courtesy, we will file and assist in obtaining payment for physical therapy services rendered directly with your insurance company.
Co-payments are due at the time of service. We contract our Billing through BMS Reimbursement Management, who will bill you for any co-insurance or deductible amount after your insurance has processed your claims. You may contact BMS at 1-800-478-2778 if you have any questions about your account statements. You may also contact the clinic directly.
Managed Care Health Plans vary in their restrictions and requirements. To assure the highest level of payment, we encourage patients to be aware of the limitations and requirements their plan offers. Some common requirements and limitations include:
- Co-pay required by patient at the time of service
- Referrals from primary care physician (PCP)
- Therapy visit limitations per calendar year
- Deductible obligations
Physical Therapy Direct Access
Massachusetts state laws provide direct access to licensed Physical Therapists without a physician’s referral or prescription. That means that as a consumer of healthcare, you can seek medical treatment for your musculoskeletal issues directly from the Physical Therapist of your choosing. This places physical therapy as a first line provider for your musculoskeletal health.
Insurance coverage for your physical therapy benefits are plan-specific. Most insurance companies do not require a referral from your physician, but some do.
Many third party payers will pay for Physical Therapy services rendered under direct access, however, the benefit is plan specific. Medicare does not pay for Direct Access Physical Therapy at this time, but Physical Therapists can perform an evaluation under direct access, and as long as a physician signs off on a treatment plan, we are able to bill Medicare.