Insurance and Payment Policies
Manual Solutions Physical Therapy is an in network provider for most a insurances servicing Southeastern Idaho. Individual policies are extremely variable but we have listed a few general insurance rules and our policies to help you better understand your coverage. We encourage you to contact your insurance company for details of your specific coverage.
Medicare and Medicaid
Medicare has a yearly benefit of $1940 and Medicaid has a yearly benefit of $1870 per year which is subject to change based on government policy. Medicare covers 85% and Medicaid covers 100% of therapy treatment. They do not cover the cost of supplies. This limit applies to a combined total of all physical therapy, occupational therapy and speech therapy expenses incurred within a calendar year. Medicare/ Medicaid require a plan of care signed by your physician which needs to be renewed every 90 days. Many physicians require that you have follow up visits to renew your plan of care.
Idaho is a direct access state meaning that you are not required by law to have a referral from your physician; however, if you are submitting to insurance, some insurance policies require a referral. If you are seeing a physician it is a good idea to get a referral to make sure that your insurance company will cover the visit. We acknowledge that the inconvenience and cost of getting a referral often keeps patients from getting care. We have many patients who choose not to submit to insurance and pay our cash rates ($90 for a new evaluation and $75 for a follow up) We encourage you to choose which ever strategy works best for you.
Several insurance companies require preauthorization prior to treatment. (I.E. Medicare advantage, Regence Blue Shield, True Blue, Secure Blue, Humana) They will not cover the cost of your visit until certain paperwork is filled out. If you have a Medicare replacement plan or are filing a workman’s compensation claim we will work with you to get approval but you may be required to wait to be treated.
Manual Solutions Physical Therapy wants open and clear communication about your bill. We do our best to keep you informed about costs and coverage. We have adopted a policy that patients cannot have a personal balance of more than $175 without a payment plan. The $175 limit does not apply to what is owed by your insurance company. We established this policy so that patients are not surprised by a large bill that they cannot pay. We have hired a billing company that will work with you to establish a payment plan based on the size of the bill and the rate at which it is growing.
Manual Solutions Physical Therapy treats many patients who are in litigation. Unfortunately, we are not able to shoulder the burden of waiting for law suits to be settled. The $175 limit applies.