Insurance, Referrals, and Billing

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Insurance

 

For physical therapy services, CORE Services, Inc is a network provider for:

• Medicare

• Aetna

• Integrated Health Plan

• Tricare

 

For biofeedback and neurofeedback, CORE Services, Inc is a preferred provider for:

• Cigna

• Cigna Behavioral Health

• Aetna

• Exclusive Choice

• SSM Managed Care

• MHNET

• Anthem/BCBS

• Harmony Healthcare

• GEHA

• MHN

• Mercy Health Plans

• Mercy Behavioral Health

 

Reasons Why CORE is a GREAT Medicare Provider:

1. We are Medicare Part B providers.

2. ALL CORE clinicians are fully licensed physical therapists or hold at least a master's degree.

3. We DO NOT use therapy extenders.

4. Our clinicians spend the entire appointment focusing on JUST ONE PATIENT.

5. All initial evaluations are scheduled for 1 hour for more thorough evaluations.

6. We specialize in complex medical histories and multiple comorbidities.

7. We understand Medicare therapy caps, when exceptions should be made and how to navigate the exceptions process.

8. We have a specialized FALL PREVENTION program that focuses on balance and gait training and integrates visual processing and biofeedback.

9. Our HYDRO TRACK under water treadmill is a hit with our older population with mobility issues. They feel liberated and are thrilled with the weight loss they enjoy.

10. We have private treatment rooms for all appointments.

11. Our generous appointment times, one on one approach, and familiarity with highly complex patients mean that our patients do not feel rushed or dismissed.

 

 

 

Referrals

 

If your insurance allows you to direct your own healthcare, we are happy to see you without an order from a physician. However, certain insurance plans, such as Medicare, require a physician's referral for physical therapy. We recommend calling the customer service phone number on your health insurance card to find out if an order from a medical doctor is mandated for physical therapy benefits. If you are covered by Medicare, you will need a prescription for physical therapy from your medical doctor. A referral from a health care professional other than a medical doctor, such as a dentist or chiropractor, will not be accepted by Medicare. Once you have received a prescription, it will expire for use in 30days. Therefore, please schedule your initial appointment within 30 days of the date of your prescription. If you have any other questions, please contact CORE Services, Inc. at 314-647-4880.

 

 

 

Billing

 

The following is intended to help you understand our billing process:

• Co-pays are due at the time of services

• Charge amounts for your visit are based on notes our billing staff receives from your therapist

• Our billing staff submits charges to your insurance company for reimbursement

• Payment from your insurance company is generally received within 30 to 60 days of submission

• A statement will be mailed to you after your insurance has made payment or other determination

• We will send you a bill monthly for any balance due after insurance has processed your claim

• For your convenience we accept cash, check, MasterCard, Visa and Discover

• Payment plans may be arranged to fit your budget. All plans require monthly payments.

• Please contact us if you wish to receive a record of your charges prior to receiving your bill.  We appreciate your understanding and cooperation and will be happy to answer any questions you may have about your billing procedures. 

• Other payers 

  • Workers compensation: We will bill your workers compensation carrier for all charges incurred at our facility.  In the event these charges are denied, the claim may be submitted to your personal health insurance plan.   If the claims are denied you are financially responsible for all charges.  In the event that you seek legal representation in the settlement of your claim, we ask that you adhere to the policies listed under "Personal Liability/Litigation". 

  • Motor Vehicle Accident: We will bill the responsible party's automobile insurance, provided the policy includeds Personal Injury Protection (PIP).  If PIP is not available, claims will be submitted to your health insurance provider.  In the event that you seek legal representation in the settlement of your claim, we ask that you adhere to the policies listed under "Personal Liability/Litigation". 

  • Personal Liability/Litigation: If you are working with an attorney for your claim, and are not yet to the point of settlement, our financial policy is as follows:

    • At the initial evaluation a lien waiver must be signed

    • The lien waiver is valid for the lesser of your settlement completion or 1 year.

    • At the end of 1 year, if your litigation is not resolved, your entire balance becomes due and payable in full.

    • At the inital visit we will require information about your attorney

    • A co-pay of $30 is required at each visit

    • If your claim is denied, you are fully financially responsible for payment

  • Self-pay: Self-paying patients are asked to pay a minimum of $100 on the first visit and $50 on each subsequent visit.  If these payments do not cover all treatment costs, you will be billed for the remaining amount on a monthly basis.  In certain situations a payment may be established to met your budget.  Please call our Business Mangager to arrange such a plan.  All payment plans require monthly payments.   If you have any other questions regarding our insurance and billing processes, please contact us at 314-647-4880.