Insurance
Understanding Out-of-Network Insurance Coverage
The following questions can help discern your out-of-network insurance coverage:
Coverage
Does my insurance cover out-of-network physical therapy?
Is there a limit to the amount of out-of-network physical therapy sessions allowed to me?
Pre-Authorization Requirement
Does my insurance require pre-authorization?
Out-of-Network Deductible
What is my out-of-network deductible?
How much more do I need to meet my deductible this year?
Once my deductible is met, what amount will my insurance pay?
Insurance & Payment Information
We want our patients to feel informed and confident when it comes to payment and insurance. Please review the information below to understand how insurance works at Restore & Rebalance.
How Insurance works at Restore & Rebalance
Dr. Sarah Petrich, PT bills insurance through Restore & Rebalance, LLC and is an out-of-network cash-based provider not enrolled in Medicare.
See note at the bottom of the page if you are a Medicare beneficiary including those with supplemental plans.
For non-Medicare beneficiaries, all physical therapy sessions can be coded for reimbursement for out-of-network insurance benefits. Everyone’s benefits are different depending on their individual plan.
Out-of-network coverage is different than in-network insurance and verifying your coverage ahead of time can avoid unexpected surprises.
Submitting a Claim to Insurance
All physical therapy sessions are paid directly by the patient at the time of your appointment. Restore & Rebalance charges an average of $180/hr. See pricing for details.
Patients can submit their invoice/receipt/superbill to insurance directly by contacting their insurance company, or can utilize an online reimbursement service (e.g., reimbursify.com) for a small fee.
Medicare Beneficiaries
The US government has laws that control where Medicare beneficiaries can spend their healthcare dollar and persuade healthcare providers to enroll in their system.
Because I am not an enrolled or a Participating Medicare Provider, I can only accept Medicare beneficiaries as patients when the patient does not want Medicare billed for any PT services.
This request to not involve Medicare in payment must be made up front by the patient and be made of the patient’s own free will.
In other words, if you’re a Medicare beneficiary and are adamant about seeing me for your care even though I’m not a participating Medicare provider, I can help — however, the only way I can provide you with PT services is when you truly don’t want Medicare involved and you ask up front that Medicare not be billed or involved in your physical therapy care.
If you do want to use your Medicare benefits for physical therapy, I cannot provide you with treatment, but I can help you find a good Medicare provider in your area.
“Movement is Medicine for creating change in a person’s physical, emotional, and mental states.”
— Carol Welch