Self Pay v.s. Insurance Pay - Understanding the Differences

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Differences Between Self pay and Insurance Pay

As of September 1, 2017, CoachAmyPT is officially an in-network provider of Blue Cross Blue Shield (BCBS). This means that patients with physical therapy coverage under BCBS can choose how they pay for services: Self Pay or Insurance. 

This brings us to the topic of the difference between the two choices. First, let us impress upon you that whether you choose Self Pay or Insurance, your care at CoachAmyPT will always be personalized and 1:1 with Coach Amy. That said, it may impact your finances and the logistics of your treatment so we recommend you compare the two and make an informed decision. 

Self Pay

  • Treatment plan of care, frequency and duration are determined as a team by Coach Amy and the patient. 
  • Cost of evaluation and treatment is known up front. No waiting for EOB's to find out how much you owe. 
  • Patient can choose at anytime to have Coach Amy evaluate and treat multiple problem areas without scheduling a separate evaluation or treatment session (e.g. neck and foot).
  • Coach Amy is always re-evaluating throughout a patient's treatment, but with Self Pay, monthly re-evaluations will not take place of your treatment time as they do with insurance. 
  • Patient is not charged an evaluation fee for each new area of treatment unless it has been a year since their last visit. 
  • Patient receives a SUPERBILL at the beginning of each month that can be used for tax purposes or to self submit to an insurance carrier that is out of network. 
  • Payment is due at time of service or can be made online when appointment is booked. We accept flex spending and health savings account cards, cash, check, and Visa, Mastercard, Discover, or American Express.

Insurance

  • Treatment plan of care, frequency and duration is limited to approval by the insurance company. 
  • Benefits for PT vary and are dependent upon the patient's particular plan.
  • Depending upon the plan, patients may need to satisfy in-network deductibles and will be responsible for payment of services at insurance rates. Please note that out of pocket charges may exceed CoachAmyPT Self Pay rates. 
  • In most cases, a separate evaluation and appointment will be needed for multiple areas of treatment e.g. neck v.s. knee unless these are directly related. 
  • Insurance does not cover maintenance and in some cases return to sport or hobby. If this is the case, a patient can choose to continue PT, but will need to switch to Self Pay.
  • Every 4 weeks, regardless of frequency of treatment, one PT session will be primarily devoted to re-evaluation and a progress note for each area of treatment. 
  • Co-pay is due at the time of service. We accept flex spending and health savings account cards, cash, check, and Visa, Mastercard, Discover, or American Express.

Making the Switch

Want to make the switch from Self Pay to Insurance? We are happy to help! Here are some key points:

  1. When you schedule your FIRST insurance covered appointment select NEW Patient Evaluation and Treatment-Blue Cross Blue Shield. You will be prompted to fill out new patient forms including providing a copy of the front and back of your insurance card.
  2. If you are currently booked for a follow-up Self Pay visit but want to switch to Insurance you can either go into your account or go to your confirmation email and choose the reschedule button. If this is your first appointment using insurance you need to select NEW Patient Evaluation and Treatment-Blue Cross Blue Shield. Do NOT select PT Treatment-Blue Cross Blue Shield. See # 1. 
  3. We are not able to retroactively bill insurance for any previous Self Pay visits. 

We look forward to continuing to provide ALL of our patients with the same level of personalized care with Coach Amy and are excited to open up our practice to include those who wish to pay with insurance.