You do not have Medicare
Straightforward cash-pay.
You pay us directly, and you can use any package or membership. We provide a detailed superbill you can submit yourself for possible out-of-network, HSA or FSA reimbursement.
Are you on Medicare?
Most of what we do is cash-pay, and for most patients that is the whole story. Medicare is the one real exception, and it is worth two minutes of your time before you book so nothing surprises you later.
Which one are you?
There are three situations, and only the third one is complicated.
You have Medicare, and you want performance work
Also cash-pay.
Golf and sports performance, TPI assessments and follow-ups, movement screens and wellness training are not services Medicare covers. They are cash-pay whether or not you have Medicare, and packages apply.
You have Medicare, and you have an injury or diagnosis
We are required to bill Medicare.
If you are a Medicare beneficiary with a treatable, covered condition, federal rules require us to submit the claim for that care. We cannot see you as a cash patient for it. How the money moves is explained below.
How the money moves
This is the part that works differently here than at most clinics, and it is the part worth understanding before your first visit.
- You pay us directly, at the Medicare fee schedule rate for the covered service. There is no copay arrangement and no balance bill later.
- We submit the claim to Medicare on your behalf. For a covered injury or diagnosis this is not optional for either of us; federal rules require it.
- Medicare reimburses you, not the practice. The payment comes back to you directly. This is what being a non-participating provider means, and it is the opposite of how most clinics you have used will have worked.
What Medicare covers here, and what it does not
Billed to Medicare
- Physical therapy for a treatable injury or diagnosis
- Recovery care after surgery
- The LSVT BIG® programme, for Medicare-eligible patients
Cash-pay, for everyone
- Golf and sports performance work, including TPI assessments and follow-ups
- Movement assessments and screens
- Dry needling
- Wellness, performance and fitness work, including after you transition out of physical therapy
This list is a guide, not a coverage determination. Whether a specific condition is covered depends on your diagnosis and your plan, which is exactly the sort of thing worth a phone call rather than a guess.
Questions we get
Why do I pay you directly if Medicare covers it?
Because we are a non-participating Medicare provider. Most clinics are participating: they collect roughly twenty per cent from you and Medicare pays them the rest. We work the other way round. You pay us directly at the Medicare fee schedule rate, we submit the claim on your behalf as required, and Medicare reimburses you rather than us. The money comes back to you, not to the practice.
Can one visit be part Medicare and part cash?
Yes, and it is common. If we treat you for a hip injury and dry needling is clinically appropriate that day, the injury care is billed to Medicare and the dry needling is a cash add-on for that visit, because Medicare does not cover it.
Can I use a package or a membership?
Not for Medicare-covered care. Packages and memberships are available to you for wellness and performance services, which Medicare does not cover, but they cannot be applied to covered physical therapy.
Do I pay a travel or concierge fee?
Not on Medicare-eligible services. You get the same home visit, the same full hour and the same therapist, with no travel or concierge charge added.
What about out-of-network insurance, HSA or FSA?
The same principle applies to everyone we see: you pay us directly, and any reimbursement you qualify for comes back to you. We provide the documentation you need to claim it, whether that is Medicare, out-of-network benefits, or an HSA or FSA.
I am not sure which of these I am.
Call 941-275-9293 and ask for Brian. Two minutes on the phone will tell you exactly where you stand, and it will be more accurate than anything a web page can work out for you.
Still not sure? Just ask.
Medicare rules are genuinely fiddly and your situation is specific. Call and ask for Brian. He will tell you plainly what you would pay, what gets billed, and what comes back to you, before you commit to anything.