Explanation of Billing for LS Therapy
Effective Date: 10/1/2023
Thank you for choosing LS Therapy for your outpatient physical and occupational therapy needs. We strive to provide you with high-quality care while ensuring transparency and clarity regarding our billing practices. Below is important information regarding billing, insurance requirements, and when you can expect to receive a bill.
Insurance and Medicare Billing Requirements
In compliance with the Price Transparency Rule issued by CMS, we have made available a machine-readable file containing our standard charges for items and services. This file provides a comprehensive list of the prices for common procedures, tests, and services offered at our practice. Please note that these charges represent the standard rates and may not reflect the actual amount due from an individual patient due to insurance coverage, negotiated rates, or other factors. For an accurate estimate of your out-of-pocket costs, we recommend contacting our billing department or your insurance provider.
Cost Estimates
We understand that financial considerations play an important role in your healthcare decisions. If you would like a personalized cost estimate for a specific procedure or service, we encourage you to reach out to our billing department. Our knowledgeable staff will work with you to provide a good faith estimate based on your insurance coverage, deductible, co-pays, and other relevant factors. Please be aware that cost estimates may vary depending on the specific details of your case, and additional charges may apply based on unforeseen circumstances or complications during your treatment.
Billing Rates
At LS Therapy, we bill each therapy treatment CPT code at $100 per unit, and each evaluation code is billed at $200. These charges have been carefully determined to align with industry standards and ensure affordable and competitive pricing for our patients. Our billing rates are in line with the recommendations provided by Fair Health Consumer, a reputable resource for healthcare cost information (https://www.fairhealthconsumer.org).
Private Pay Information
Private Pay Services available for clients without insurance or for those that choose not to bill insurance, except for services covered by Medicare and Medicare Advantage Plans. We are required to bill Medicare for services that are skilled and medically necessary. Medicare Advantage plan requirements depend on the type of plan. Private Pay Services are available to Medicare beneficiaries if the service provided is no longer skilled and medically necessary. A Prompt Pay Discount is available for Private Pay clients that pay at time of invoice. The Prompt Pay Discount is based on the Medicare Fee Schedule. Private pay clients will be provided with a good faith estimate.
Receipt of Billing Statements
You will receive a bill if there is a balance remaining after your insurance company has paid for the covered services. Billing statements are generated once insurance has processed the claims and determined the patient’s responsibility. For insured patients, statements are generated after insurance processing. For uninsured patients, statements are generated as soon as the charges are billed to your account during your normal billing cycle. The status of your account will be clearly indicated on each statement.
Understanding Billing Amounts
Please be aware that the prices listed on the billing statements are the amounts billed to your insurer. However, the actual amount you are required to pay out-of-pocket may vary. Providers are often reimbursed at rates lower than the charges. Commercial insurance patients may have negotiated rates, while Medicare and Medicaid patients have reimbursement rates determined by federal and state governments.
Reasons for Delayed Billing
If you receive a bill several weeks or months after the services were provided, it is because we process and send billing statements after payment is received from the insurance carrier. The time required for this process depends on how long it takes to receive a response from your insurance carrier. Additionally, if your insurance carrier denies the initial claim, we may initiate an appeal to secure payment for the services provided, which can further delay your billing.
Understanding Your Insurance Coverage
It is essential to familiarize yourself with the coverage, co-insurance and co-pay requirements of your specific insurance plan. We cannot predict which services will be covered by individual health plans. Some plans may limit payments to “usual, customary, and reasonable payment.” To obtain coverage information, please consult your employer, insurance agent, or refer to the details provided by your insurance plan. For Medicare beneficiaries, you can find information on Medicare benefits at your local Social Security office or online at https://www.medicare.gov/
Pre-Certification and Prior Authorization
Many health plans require pre-certification and sometimes predetermination of medical necessity before care is rendered. Additionally, certain services may not be covered benefits under some insurance plans. Investigating coverage requirements and limitations can take time. It is the patient’s responsibility to understand the pre-certification requirements of their health plan. We recommend contacting your insurance company to determine the benefits and coverage specific to your plan.
We hope this explanation of our billing practices provides you with the necessary information. If you have any further questions or concerns, please feel free to contact us.
We are committed to creating an environment that values diversity, fosters respect, and ensures equal access to healthcare services for all individuals. If you have any questions or need further information regarding our non-discrimination policy, please do not hesitate to contact us.
LAST EDITED ON: 12/5/2024
MEDICAL DISCLAIMER:
All information on this website is intended for instruction and informational purposes only. The authors are not responsible for any harm or injury that may result. Significant injury risk is possible if you do not follow due diligence and seek suitable professional advice about your injury.
No guarantees of specific results are expressly made or implied on this website.
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