Essex Physical Therapy contracts with many insurance companies and we do our best to assist you in understanding your individual policy. We recommend that you call your insurance company prior to your visit, as it is your responsibility to know the requirements and/or limitations for Physical Therapy services and to fully understand your specific insurance policy. We are happy to work with you to help understand this complex system and will bill your insurance for you when possible.

If you are covered by Medicare, you will need a prescription or referral for Physical Therapy from your medical doctor. A referral from a different health professional, such as a dentist or chiropractor, will not be accepted by Medicare. Once you have received a prescription, it will expire for use in 30 days. Therefore, please schedule your first appointment during that 30 day time period.

Effective January 1, 2006, a financial limitation (therapy cap) was placed on outpatient rehabilitation services received by Medicare beneficiaries. These limits apply to outpatient Part B therapy services from all settings except the outpatient hospital clinics. The cap imposed by Congress for Physical and Speech Therapy (combined) per calendar year is $1,870. If you have had either of these services in an outpatient facility, please contact Medicare to find out how much of your $1,870 remains for this calendar year.

Determine the following from your insurance plan:

1.Do I have a co-pay or co-insurance for Physical Therapy? If there is a co-pay how much is it? If there is co-insurance, what percent is it and when does it start applying?

2.Do I have an Individual or Family deductible for Physical Therapy? Have my deductibles been met?

3.Is there a maximum dollar amount or maximum number of visits per year for Physical Therapy?

4.Is there a time limit by which completion of services provided under a specific diagnosis needs to occur?

Co-payments – Per your own plan, co-payments are per-service charges due at the time of your visit.

Co-insurance – Per your own plan, co-insurance is a percentage of the allowable amount approved by your insurance plan that you will be responsible to pay. We will bill your insurance company after your visit and will bill you for the portion of the service they determine is co-insurance. We expect payment of co-insurance at the time of your next visit.

Deductible – Per your own plan, the amount you are responsible to pay, before your plan begins to pay for covered services. We will bill your insurance company after your visit and will bill you for the portion of the service they determine is deductible. We expect payment of deductible at the time of your next visit. Since your insurance plan will likely pay more towards your health care services after your deductible is met, we will have to report any unpaid deducible balances to your insurance company so that they may re-apply these dollars to your amount due.

***Please keep in mind that any Physical, Speech or Occupational Therapy provided to you will be applicable to your yearly limitations. To determine if your insurance carrier is accepted by Essex Physical Therapy and to be connected to your provider’s website, please refer below.

We have therapists as participating providers for the following insurance companies:

**Please keep in mind that all therapists may be listed individually as participating providers with insurance companies, or may be listed under “LeClair Therapy” or “Essex Physical Therapy.” While we encourage all patients to call their Member Benefits office to verify participation, please be sure to know the name of the therapist you will be seeing to confirm eligibility.