Cash pay physical therapy options At Synergy Physical Therapy in Spokane Valley

Published by Shauna Burchett, OTR/L on

Synergy Healthcare in Spokane Valley accepts many types of insurance – but we’ve recently received inquiries about our cash pay options. The following article explains a bit more about cash pay physical therapy.

What are the benefits of cash pay physical therapy?

Synergy Physical Therapy in Spokane Valley offers a cash payment option for patients who don’t have insurance or whose insurance does not cover physical therapy treatments. In a cash-based treatment model, the physical therapist enters into a contract with the patient instead of an insurance carrier. This contract aims to provide physical therapy services to the patient in a manner that both parties have determined will help them reach the patient’s treatment goals most efficiently. In a cash-based treatment model, the only two parties involved in the contract for care are the therapist and the patient. A cash pay option allows the therapist to provide clinical treatment based on the need of each individual without third-party insurance reviews, network restrictions and visit limits. 

The patient pays in advance or at the time of service. Even though this model is called cash-based, the patient is not limited to cash payments. If you’re considering cash pay, you may pay for services with cash, credit, debit, check, Flexible Spending Accounts (FSA), Health Savings Accounts (HSA), and Health Reimbursement Accounts (HRA).

Cash-based billing eliminates the confusion that can accompany complex billing codes required by insurance. In turn, it allows for clarity in decision-making by the patient and their physical therapist. 

Can my insurance be billed for cash pay physical therapy services? 

Most insurance companies, with some exceptions (Medicare, Medicaid, and some HMOs), will provide payment for services received “out of network.” Going out of network means you, the patient, have the choice to see a physical therapist who is not a participating provider with your insurance company. Many patients choose to receive services out of network to see the physical therapist they believe can best resolve their challenges. 

Patients who choose cash-based services may still submit documentation to their insurance company. The insurance company will reimburse the patient upon receipt of the documentation. There are certain insurances that Synergy will bill directly for the patient. The patient will receive the check from the insurance directly, as Synergy does not accept assignment for the payment.

Synergy Healthcare in Spokane Valley offers cash payment options / can operate as an “out of network” provider – what does this mean? 

This means you can receive treatment at Synergy Physical Therapy in Spokane Valley, regardless of your insurance carrier. While we accept many kinds of insurance, we have not contracted with some. Since there are MANY insurance companies, each with its own contracted rates and regulations, it would be impossible to work with every insurance carrier. However, if your insurance is not one we have a contract with, you can still benefit from care at Synergy Physical Therapy in Spokane Valley.

What about referrals?

Washington is a Direct Access state, meaning patients who pay cash do not have to obtain a prescription for physical therapy from their physician before starting treatment. If you’re in pain or think a physical therapist could help you with another issue causing discomfort, you can schedule an appointment right away. You don’t need to wait for a referral. 

What are the steps to submit a cash pay physical therapy claim to my insurance company?

The process is quite simple: Synergy Physical Therapy will provide you with an invoice at the time of service. You may submit that invoice and your receipt of payment for said service to your insurance company for reimbursement. The invoice we will provide you 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 (billing) codes. You may choose to submit bills following each visit, one time per month, or at any other interval, typically up to one year following your treatment visit.

My insurance carrier is Medicare – are there any special rules that apply?

Outpatient physical therapy services are covered under Medicare Part B, provided the service is considered medically necessary to treat a disease or condition. Under current Medicare regulations, it is illegal for a physical therapist to accept cash payments from Medicare patients for services that may be covered under Medicare. Unfortunately, we cannot offer out-of-network or cash pay options to our patients with Medicare at this time. 

We’re here to help!

Insurance matters can be confusing. Don’t hesitate to contact our office, to get your questions answered. In many cases, our expert staff can check your insurance on-the-spot to help you understand your options.

Shauna Burchett, OTR/L

Shauna Burchett, OTR/L is a skilled occupational therapist and the owner of Synergy Healthcare. She graduated from the University of Alberta in 1993 with a degree in Occupational Therapy. Shauna began her career as an occupational therapist specializing in traumatic head injuries. She has also worked in skilled nursing facilities specializing in long and short term geriatric rehabilitation. Shauna has been in private practice since 1998.