+ Why is the clinic "out-of-network" with all insurances?

Insurance companies heavily influence and dictate the treatment that patients receive at typical Physical Therapy clinics. I refuse to allow that to be the case at Mountain Ridge Physical Therapy. Each of my patients receives one-on-one care that emphasizes manual hands-on therapy and constant assessment. This allows results to be faster than average. After you consider the time savings of fewer trips to the clinic and the value of resolving your pain at a faster rate, the out-of-pocket expense at Mountain Ridge Physical Therapy can be a huge savings. These features are no longer possible with an "in-network" clinic.

+ Why don't we directly bill insurance companies?

It comes down to treatment philosophy. Insurance is not billed because it does not support the treatment model that I like to follow. By being "out-of-network" I enter into a contract with you, the patient, to provide treatment in a manner that both of us have determined will help achieve the treatment goals most efficiently. Payment is due at the time of service. Mountain Ridge Physical Therapy does not accept insurance, but you can still submit for reimbursement. The patient pays at the time of service which allows me to focus on the best possible treatments and avoid unnecessary administrative costs.

+ What is the difference in treatments at Mountain Ridge Physical Therapy and traditional clinics?

Physical Therapists in an insurance-based clinic have to sacrifice quality for quantity of patients. This means they typically have to see at least 2 patients per hour (often much more) and use technicians/aides to apply multiple modalities like ultrasound and electrical stimulation or to monitor you as you perform their version of therapeutic exercise. They have a need to do this because insurance companies typically reimburse these clinics about half of what they billed. As a result, your quality of care suffers and you may not improve as much as you should. I do not believe that modalities and aide-led exercises are as effective as my skilled manual therapy, therapist-led therapeutic exercise and constant attention. I do not believe that patients should pay to perform exercises in a clinic for 30-60 minutes that they can easily perform at home. Patients get better faster when they have one person monitoring their progress and treatment.

+ Can I bill my insurance for reimbursement of my out-of-pocket expenses?

This depends on the insurance you have, but YES, the majority of patients can get reimbursement for their treatments. The amount of reimbursement varies with each insurance plan. You could submit bills following each visit, one time per month, or at any other interval, often up to one year following your treatment visit. Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide payment for services received "out-of-network". Choosing to go out-of-network means that you have the freedom to choose a Physical Therapist who is not a participating provider with your insurance company. It means that you can receive the care that is optimal for your personal needs, not what is best for your insurance company's bottom line. If reimbursement is provided, the insurance company will mail you a check directly. If you call your insurance company to inquire, you should specifically ask about reimbursement for “out-of-network Physical Therapy” expenses.

+ What steps are involved in submitting a claim to my insurance?

The process is very simple. You should be able to print claim forms from your insurance company’s website and send those in with the needed receipts and treatment codes that will be provided to you at the clinic. The invoice has all of the necessary information (business name and address, tax ID, national provider identification, license numbers, etc.) as well as the patient’s ICD-10 (diagnosis) and CPT treatment (billing) codes. If you call your insurance company to inquire, you should specifically ask about reimbursement for “out-of-network Physical Therapy” expenses.