We gladly accept the insurance plans listed below. If your plan is not listed, please call us as we are always adding new insurance plans.
As a courtesy to our patients, we will verify your health benefits prior to your arrival to determine if there will be a copay, deductible, or coinsurance for therapy services.
For those patients who do not have health insurance or those who have maxed out their benefits, we offer a private pay plan. Please contact Orthopedic & Balance Therapy Specialists today at Valparaiso, Crown Point & LaPorte, IN centers for more information on our fees for service and payment details.
Disclaimer: While this is an extensive list, health plans do change regularly without prior notification. We recommend that you verify with your health plan what physical therapy benefits you have available.
- AARP United HealthCare
- Align Networks
- Allied Benefit Systems
- Bankers Fidelity
- Benefit Management Services
- Blue Cross Blue Shield Indiana
- combined insurance
- Continental General Insurance Co.
- Core Benefits
- Equitable and You
- Farm Bureau Heath Plans
- FORE THOUGHT
- GALLAGHER BASSETT
- GEHA (Government Employees Hospital Association )
- Gerber Life Insurance Company
- Golden Rule Insurance (UnitedHealthOne)
- HealthSCOPE Benefits Inc (ECHO Health Plan)
- Local 697
- Lutheran Preferred
- Medicare Part B Indiana
- Medicare Railroad
- MedPartners Admin Services
- Members Health Insurance Company
- Mutual Omaha Insurance
- National Association of Letter Carriers
- New ERA Life
- Optum Health
- Philadelphia American Life Ins
- Pipe Fitters Welfare Fund Local 597
- Prairie States Enterprises Inc.
- Professional Benefit Administrators Inc.
- ROSEWOOD RESTAURANT INSURANCE
- Safe Auto Insurance
- SMW Plus
- Standard Life & Accident Insurance (ECHO Health Plan)
- State Farm
- The Hartford
- Thrivent Financial for Lutherans
- Trans America
- Tricare for Life
- UMR Wausau / UHIS
- United American
- United Healthcare
- UnitedHealthcare Shared Services
- Web TPA
A co-payment is a per-person, per-visit amount that you are expected to pay before your insurance company begins covering the cost of your care. The provider of care is directed by the insurance company to collect the co-payment from the patient prior to treatment.
A deductible is a fixed dollar amount during the benefit period that an insured person pays before the insurance company starts to make payments for covered medical services.
Co-insurance is a form of medical cost sharing that requires an insured person to pay a stated percentage of medical expenses after the deductible has been met.
The charges are determined based upon the services provided to you by your treating therapist.
The therapist may change your treatment program in the middle of your treatment plan or may try something different if you are not responding to the treatment. In which the charges will be different on different dates of service.
The charges are determined based upon the services provided to you by your treating therapist on each date of service. If the therapist adds, changes, or removes any services on a given date, your charges for that date may change. For most insurance plans, we are required to bill according to national uniform medical billing codes (CPT codes), which is standard practice for medical claims for most medical providers and hospitals.
Payments are posted to each date of service that has an open balance. If your payment was more than the balance on one claim line, the maximum amount that can be posted to that claim line is the current balance. Any remaining amount from your payment will be posted to subsequent claim lines. For example, if you paid $100.00, your payment could show as five (5) $20.00 payments for five different dates of service instead of one $100.00 payment.
Payments received are applied to claims that have open patient balances from the oldest date of service to the newest date of service. Insurance carriers sometimes process the dates of service out of order. Therefore timing differences can cause more recent dates of service to be paid before older dates.
Patient statements are generated monthly. Any account that has a current balance sitting as patient responsibility will have a statement generated. Monthly statements will continue as claims are processed by the insurance and additional amounts become the responsibility of the patient. Once all claims are processed by the insurance and all patient responsibility has been satisfied, monthly statements will no longer be generated.
The charged amount is the amount the therapy clinic charges for each treatment code. The amount that insurance pays which is called the Allowed Amount, is the most they will pay for that service. If you have a deductible remaining, you will be responsible for the charges until it is met. If you have a coinsurance, the insurance will pay the allowable amount & you will be responsible for the % that is yours and the rest will be adjusted off.
The in-office costs are estimated according to the insurance reimbursement rates. We take the reimbursement rates for each therapy code that is charged (for your specific diagnosis) and we add the costs together which will give the estimated cost for a deductible payment. If your deductible is met, then we will multiply that deductible estimate by your coinsurance cost share which will give you the amount to pay for coinsurance. NOTE: This amount is only an estimated amount. The insurance may pay more or less of the charges submitted which will leave you either owing a little more or you will get a refund when all charges are finalized.
All Medicare Deductibles start over at the beginning of every year. We will verify with Medicare how much or if any of your Medicare Deductible has been met. You may have seen a doctor or had a procedure or surgery done before you came for physical therapy, that treatment has to be performed by a Part B professional provider in order to go towards your Part B Deductible. If it was treated in a Hospital, it will go towards your Part A Deductible, Part A & Part B both have 2 separate deductibles to be met. In that case, if it was in a hospital, we will collect the Part B Deductible at the time of your evaluation. If you were treated by a Part B Professional Provider within 1 or 2 weeks prior to coming for physical therapy, we will not collect because more than likely, that visit will be applied towards your deductible. If any amount is left over, after you start physical therapy, we will bill you for that amount.