Insurance

 

OCS-PT aims to maintain a solo-practice model with minimal administrative overhead cost in order to provide high quality physical therapy services to our clients. Instead of spending the effort and energy in dealing with the insurance companies, we are to focus all our attention on patients’ care.  A heavy insurance-based physical therapy practice often focus on the number of patients seen in a day so as to maximize profit due to the fact that insurance companies almost always pay a discounted rate for therapy services under a contractual agreement. In order to make a profit, a heavy insurance-based PT practice also often employs inexperienced therapists and/ or assistants as well as to see more patients within an hour. Every one of our patients receives up to an hour of one-on-one care, which includes ongoing physical assessment, hand-on treatment and a customized therapeutic exercise program targeting specific physical impairments so as to reduce pain and to maximize function. The goals of therapy are also individualized with consideration of patient’s age, gender, physical activity level, and sports participation (if any). Insurance-based PT clinic will not provide physical therapy services for the purpose of wellness, return-to-sports program as well as injury prevention.

 

 

 

Do I need a referral?

Consumers are not required to have a referral or diagnosis in order to receive physical therapist services in the State of California. Physical therapist services may be obtained without a physician’s referral if you are a cash carrying patient, receiving treatment for up to 45 calendar days/12 visits, receiving health and wellness services, or if you are a UnitedHealthCare or Medicare beneficiary.

 

The following passage is an article extracted from the website of the Physical Therapy Board of California:

 

Under California law, you may continue to receive direct physical therapy treatment services for a period of up to 45 calendar days or 12 visits, whichever occurs first, after which time a physical therapist may continue providing you with physical therapy treatment services only after receiving, from a person holding a physician and surgeon’s certificate issued by the Medical Board of California or by the Osteopathic Medical Board of California, or from a person holding a certificate to practice podiatric medicine from the California Board of Podiatric Medicine and acting within his or her scope of practice, a dated signature on the physical therapist’s plan of care indicating approval of the physical therapist’s plan of care and that an in-person patient examination and evaluation was conducted by the physician and surgeon or podiatrist.

 

 

Do you accept Medicare?

OCS-PT is a medicare provider. By law, we do not need a referral for physical therapy evaluation. However, we do need a signed plan of care from a medical practitioner (MD, DO, NP, PA, DC, DPM, DDS) in order to carry out the treatment plan. You may either obtain a physical therapy referral from your family physician prior to making your appointment or we can take care of that for you after we complete the initial evaluation.

 

 

Do you accept other insurance?

OCS-PT is currently in contract with Blue Shield PPO plan, Tricare, as well as San Francisco Health Plan in the network of North East Medical Services. For out-of-network services, we may provide you with a receipt with the required treatment codes to receive reimbursement from your insurance company upon request. 

 

 

How can I get reimbursed from insurance for the out-of-pocket expenses?

This depends on the type and specific plan of your insurance. We recommend that you call your insurance company to inquire about “reimbursement policy for out-of-network Physical Therapy expenses”. Some insurance companies may require pre-authorization for out-of-network services. In most cases, you should be able to print claim form off your insurance company’s website, and send it in with the receipts and treatment codes. OCS-PT can provide you with a receipt including the required treatment codes upon request.

 

 

How many visits do I need for full recovery?

This is always a difficult question as recovery depends on many factors such as the type of injury, stage of a disease process, the length of time since the onset of symptoms, as well as the general health of the patient. Other factors such as physical demand of patient’s job, daily activity and/ or sports demand may also determine the type of rehabilitation program as well as the degree of improvement.  In general, patients usually perceive some degree of improvement within 2-3 visits as every single patient at OCS-PT is being evaluated thoroughly and being managed by evidence-based therapy.