INSURANCE

I am a Medicare provider in the State of Florida, and I am in-network with many insurance carriers.  If you have specific questions regarding your insurance coverage, please email us at pcmswfl@gmail.com.

We are In-Network with the following

Insurance Companies:

·   Medicare B

·   United Healthcare

·   Cigna

Auto Accident Claims.  

Occupational Therapy services may be covered under benefits, but will need to be prescribed by a physician.  We would need to get prior authorization from the auto insurance company, and we will be glad to check into that benefit for you.

What is “Out of Network”?

There are some insurance companies that limit the number of “In-Network” Providers they allow.  You need to be aware of who is on your Provider List; both “In-Network” and “Out-of-Network.”  Co-pay amounts will be different.  You also need to keep in mind that the “Provider List” your insurance company posts can change.  Stay on top of the information. 

 

There are some situations where an insurance carrier may allow an “out of network” provider work with you, if there is not the same kind of service within a certain mile radius. That information should be identified in your policy, or available through calling your insurance company's customer service department.

 

 The bottom line is know your policy, so you can get the best benefit from it.

Personal Injury/Workers Compensation Claims.  

Occupational Therapy is often a covered service when prescribed by a physician.  We can check your coverage prior to requesting the physician referral, if you email or call us with your information.

Medicare Reminders: 

a.  There is an annual deductible for each calendar year that has to be met by each person receiving Medicare benefits.  The deductible amount changes each year after January 1st of the new calendar year. We do not collect the deductible up front, but wait until the billing has been received by Medicare and follow their determination as to any amount due.  That same process applies to co-pays.  We do accept Visa and MasterCard for payment.

 

b.  Medicare pays for out-patient Occupational Therapy under Medicare B.  Medicare A is used to pay for hospital stays, nursing home skilled unit care and home health.  Our billing is considered out-patient, and the place of service is the patient's home.  Medicare places an annual limit on the dollar amount that is allowed for Physical Therapy and Speech Therapy, and a separate amount for Occupational Therapy.  Prior to initiating therapy services we confirm the amount of therapy services that they have already paid for within the same calendar year, so you will always know where you stand with payment for services.

Private Pay:  

We do accept private pay patients with a physician referral for therapy.  Case Management services do not require a physician referral.  Please contact our office for specific rates for an Evaluation.  Once the Evaluation is completed, a Treatment Plan will be established and payment for services can be determined.

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