Cash-pay means you pay for the visit yourself, and if you have a PPO plan the clinic gives you a superbill, an itemized receipt you send to your insurer for reimbursement. Direct-pay visits are $175 for the first evaluation and $125 for each follow-up visit.
What cash-pay physical therapy means
Cash-pay, also called direct pay, means you pay for your own visits. Direct-pay patients are welcome at Chatsworth Physical Therapy. How it works depends on your situation.
- No insurance.Physical therapy without insurance means you pay for each visit yourself: $175 for the first evaluation, then $125 a visit.
- A PPO plan.You pay at the visit, then send your insurer a superbill and ask for reimbursement.
- Medicare or a personal injury case.These work differently from cash-pay. The last section says where to start.
What a visit costs
The first evaluation is $175. Each follow-up visit is $125.
The evaluation is a full first visit: Dr. Ed checks how you walk and move, tests your mobility, finds the pain points and confirms your pain is mechanical, the kind physical therapy treats. If it is not, he tells you and refers you to the right doctor.
A visit runs about 60 minutes, depending on what you need, and every one is one-on-one with Dr. Ed, from your first evaluation through discharge.
How many visits you need depends on your condition and how your body responds. Dr. Ed sets the plan after your first evaluation rather than guessing up front, so he does not quote a number of visits before he has seen you.
How a superbill works
A superbill is an itemized receipt you send to your insurer for reimbursement. Itemized means it lists each service you paid for. The clinic provides the superbill, you send it, and your plan decides what it pays back.
A worked example
Say you have a PPO plan and you book a first visit. The steps leave out amounts on purpose, because the amounts depend on the clinic's rate and on your plan.
- Ask your insurer first. Find out whether your plan reimburses physical therapy that you pay for yourself, and how it wants a superbill sent.
- Come in for the visit. The first one is an evaluation with Dr. Ed.
- Pay at the visit. You pay the clinic yourself.
- Get your superbill. This is the itemized receipt you will send in.
- Send it to your insurer. Use the method your insurer gave you in the first step.
- Your plan decides what it pays back. Only your insurer can tell you the amount.
What your insurer decides
Four terms from the HealthCare.gov glossary will help when you call your insurer.
- PPO plan.The HealthCare.gov glossary defines a PPO as a type of health plan that contracts with providers to create a network. It adds: "You pay less if you use providers that belong to the plan's network. You can use doctors, hospitals, and providers outside of the network for an additional cost."
- Non-preferred provider.The HealthCare.gov glossary defines it this way: "A provider who doesn't have a contract with your health insurer or plan to provide services to you." It adds: "You'll pay more to see a non-preferred provider."
- Out-of-network coinsurance.The HealthCare.gov glossary defines it as the percentage of the allowed amount that you pay, for covered health care services, to providers who do not contract with your health insurance or plan. It adds: "Out-of-network coinsurance usually costs you more than in-network coinsurance."
- Allowed amount.The HealthCare.gov glossary defines it this way: "The maximum amount a plan will pay for a covered health care service." It adds: "If your provider charges more than the plan's allowed amount, you may have to pay the difference."
These are general definitions. They do not tell you what your plan will pay back for a superbill. Only your insurer can tell you that, so ask it about each of these before your first visit:
- Whether your plan reimburses physical therapy when you pay the provider yourself and send in a superbill.
- What the plan needs with the superbill, and where to send it.
- Whether there is a deadline for sending it in.
- What share of the cost you would pay yourself.
- Whether it wants a referral or approval from your doctor first.
What to do next
With the rates on this page in hand, put the questions above to your insurer. For Medicare, a personal injury case or any other way to pay, start with insurance and cost. When you are ready, book below.