Tel: 980-785-3733
FREQUENTLY ASKED QUESTIONS
Our goal is to provide as much clarity and information up front for our clients so that there are no surprises. Have a question you don't see listed? Send us an email and we will get back to you as soon as we can!
YES! The state of North Carolina and the state of Maryland are part of 20 states that allow patients total, unrestricted access to a physical therapist. According to state law, no type of physician referral is required for a physical therapist to evaluate or treat a patient.
For patients in Florida or New York who wish to be seen via Telelhealth: state law allows a patient to be seen for 30 days or 10 visits (whichever comes first) before requiring a referral from a physician.
After years of working with insurance companies, Dr. ashley O'Rourke founded Tidal Sports Rehab & Recovery in order to improve and simplify the patient experience. by cutting out the middle-man (insurance companies who often dictate the plan of care), patient and practitioner are able to focus on YOUR goals and not those set forth by the insurance companies.
Typically, coding for physical therapy services provided (CPT codes) is determined using a complex matrix of "timed codes" and "untimed codes". This often results in confusing patient bills, as the amount billed to insurance will vary visit to visit based on the exact services provided that day. Cash-based billing eliminates this confusion and allows for clarity in decision making on the part of the patient and their provider. Documentation for evaluations, treatment visits, and progress notes are performed just like any physical therapy practice and comply with all legal requirements.
On average, most patients have insurance deductibles of $5,000 or more. The average PT clinic bills insurance $250 per session, the cost of which is the patient’s responsibility until they meet their deductible. At Katie Andrew PT, we keep our treatment prices affordable (less than half of what most PT clinics bill to insurance) to allow you to use your HSA card, provide an invoice for your insurance, and still provide exceptional care.
She usually tells them they should determine their deductible, coinsurance, and copay for in-network physical therapy: “Many patients have a $30–$50 copay per in-network visit,” she says. “And most in-network PT clinics want to see patients two to three times per week.” Wendel explains to those patients that they could pay $90 per week in copays, or they could see her once a week for highly personalized treatment for only a little bit more. “For some patients,” Wendel says. “It’s just a matter of educating them so they understand the cost. And then it’s all about value—either a patient values the care you offer or they don’t. The ones that don’t aren’t your target audience anyway.”
In a cash-based treatment model, the physical therapist enters into a contract with the patient to provide physical therapy services in a manner that both parties have determined will help them reach treatment goals most efficiently. The patient pays at the time of service, allowing the therapist to focus attention on providing the best possible service while keeping administrative costs low. You may pay for services using actual cash, a check, or a credit/ debit card (HSA/FSA cards also accepted).
Typically, coding for physical therapy services provided (CPT codes) is determined using a complex matrix of "timed codes" and "untimed codes". This often results in confusing patient bills, as the amount billed to insurance will vary visit to visit based on the exact services provided that day. Cash-based billing eliminates this confusion and allows for clarity in decision making on the part of the patient and their provider. Documentation for evaluations, treatment visits, and progress notes are performed just like any physical therapy practice and comply with all legal requirements.
This simply means that the therapist has not entered into a contract with individual insurance companies to receive reimbursement based on their contracted rates. There are MANY insurance companies, each with their own contracted rates and regulations, and Tidal Sports Rehab & Recovery’s energy is best spent working with patients. It is important to note that in network provider status is not currently based on education, experience, skills, or treatment outcomes, but is often determined by the number of providers in a demographic area.
In many cases, the out of pocket expenses for a course of physical therapy will actually be LESS for services provided at Tidal Sports Rehab & Recovery. In large part, this is due to the ability to charge less per visit, with these charges being well below the national average charge submitted to insurance in a typical fee for service outpatient practice. Tidal Sports Rehab & Recovery can charge less because the simplified cash-based fee structure streamlines billing and does not require hiring billing personnel or paying fees to a third party billing service. This allows Restore Physical Therapy staff to focus all energy on patient care, and allows patients to make informed decisions regarding the costs of their health care choices.
A 60 minute evaluation will be billed to insurance companies at anywhere between $225 to nearly $300 for that evaluation alone. Then about $175-$225 for a follow-up. So:
Insurance-Based Clinic:
1 evaluation (45-60 minutes) + 3 physical therapy visits (30-45 minutes) = 135-195 minutes.
1 evaluation ($275-$300) + 3 physical therapy visits ($175-$225) = $800-$975 billed to insurance.
Sometimes the insurance company will show a “discount” on a patient’s EOB (Explanation of Benefits) and an amount like this will come out to $700-$850 after discounts are applied. That “discount” ultimately reduces the clinic’s bottom line. Guess how clinics typically respond after a number of discounted rates come in? (Hint: They stop accepting that type of insurance, they prioritize patient's with other insurance companies ahead of you, or they base your treatment on what codes they will be reimbursed more for- instead of what is best for you.)
In this scenario you are spending $3.58-$4.35 per minute in the clinic. If this clinic happens to use support staff (aides, techs, or assistants) to administer care then you are spending only a fraction of that time with your actual therapist.
In this day and age, it is likely that your deductible is going to be well over $1000 per year. This means that you will be responsible for the entire bill (which you will not receive until about 4-8 weeks later). SURPRISE! You wind up with a bill much larger than you expected and, in the meantime, you have likely been attending additional sessions adding more to your tab not realizing how much it is costing you per session. With a high deductable, your insurance company doesn't pay anything- they just get you a "discounted rate" which, in the end, many times is still more than the cash-based rate that we charge! This scenario doesn’t even factor in copays per visit if you have them...
Cash-based Clinic
This one is pretty simple.
1 evaluation (60 minutes) + 3 physical therapy visits (3 x 60 minutes) = 240 minutes
1 evaluation ($100-$150) + 3 physical therapy visits (3 x $100-$150) = $400-$600 billed to patient upfront or paid in installments.
No copays, no deductibles, no out-of-pocket maxes to meet (that are rarely ever met without some sort of medical catastrophe).
That equates to $1.67-$2.50 per minute in the clinic. Not only does this route get you a better dollar per minute ratio, but it also gets you the following:
-A therapist who is not drowning in paperwork
-A therapist who is not drowning in other patients
-A therapist who crafts a plan of care that is not predicated on “playing the game” of insurance authorization
-A clear and concise plan towards the goals that matter to you and your quality of life.
Not to mention that most insurance plans still allow for out-of-network benefits and will accept itemized invoices from the cash-based provider for partial reimbursement to you (Making it even CHEAPER per minute!)
Possibly! It is possible for insurance companies to reimburse patients depending on the individual provider and plan. There is no guarantee that your insurance company will reimburse you for the services, however, Tidal Sports Rehab & Recovery can provide you with the paperwork necessary to submit your claim. It is the patient's responsibility to do so and also to provide payment in full, up front, at the time services are rendered.
Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide payment for services received "out of network". Going out of network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. Many patients choose to receive services out of network in order to see the physical therapist of their choice. In the case of cash-based services, it is the patient who is waiting for reimbursement rather than the provider.
Disclaimer: Tidal Sports Rehab & Recovery provides the required documentation, but is not responsible for reimbursement processing. Insurance companies reimburse patients according to their out-of-network benefits. Reimbursement benefits vary from company to company. Please make sure you understand the terms and conditions of the reimbursement eligibility and process through your insurance provider.
The process is actually quite simple: Tidal Sports Rehab & Recovery will provide you with an invoice at the time of service, and you may submit that invoice and receipt to your insurance company for reimbursement. The invoice has all of the necessary information (business name and address, tax ID, national provider identification, license numbers, etc.) as well as the patient’s ICD-10 (diagnosis) and CPT (billing) codes. You may choose to submit bills following each visit, one time per month, or at any other interval, typically up to one year following your treatment visit.
Yes! We can treat up to a group of 3 people at one time for 1 hour Physical Therapy Treatment Sessions or 1 hour Recovery Sessions and up to 2 people for 30 min Recovery Sessions.
*Physical Therapy Initial Evaluations may not be performed in a group setting and must be completed individually prior to group treatment sessions.
The rates are listed below:
-PT Treatment (2 people): $180 ($95/person)
-PT Treatment (3 people): $285 ($95/person)
-1 hour Recovery (2 people): $130 ($65/person)
-1 hour Recovery (3 people): $195 ($65/person)
-30 min Recovery (2 people): $90 ($45/person)
Yes. Many times injuries to multiple body parts are related to one another. Evaluations and treatments take on a comprehensive, full body approach. While it is often recommended to focus on one body part at a time in order to recover more quickly, the physical therapist will discuss your specific case with you, take into consideration your goals and preferences and develop a plan of care together.
We are a concierge service meaning WE COME TO YOU! Many of our patients wish to be treated in the comfort of their own homes, however, the physical therapist will come wherever is most convenient for you: offices, soccer field, apartment/condo gym etc. It is the responsibility of the patient to ensure the location is accessible and appropriate for the treatment provided.
Don't feel comfortable having someone come to your home? We also offer in-gym sessions inside Fitness on Demand (Mooresville) and Q Athletic Performance Center (Mooresville) by appointment.
While we specialize in treating orthopedic and sports injuries, we are competent in treating a wide aray of conditions. Not sure if we treat your condition? Text, email or call for more information!
-Post-surgical orthopedic procedures
-ACL tear/rotator cuff tear/labral tear
-Arthritis
-Back Pain
-Neck Pain
-Sciatica
-Ankle Sprain
-Post-Dislocations/Instability
-Diastasus Recti (postpartum)
-Prenatal back pain
-Chondromalacia
-Patellafemoral Pain Syndrome (PFPS)
-Osgood Schlatter's Disease
-Tennis/Golfer's Elbow
-Carpal Tunnel
-Stenosis
-Spondylitis
-Spondylolysis/Spondylolisthesis
-Whiplash
-Nerve Pain
-Tendinitis
-IT Band Syndrome
-Bursitis
-Ligament Sprain/Muscle Strain
-Shoulder impingement Syndrome
-Hip Impingement/FAI
-Baker's Cyst
-Neurological Conditions
-Amputations (case by case)
-Concussion
- AND MORE!
-Injury Evaluation & Treatment
-Injury Prevention
-Sport Performance Training
-Postural Evaluation & Movement Screening
-Therapeutic Massage
-Gait Training/Crutch, Cane, Walker Use
-Balance Training
-Therapeutic Exercise
-Joint Mobilizations
-Mobility Work
-Stretching
-Soft Tissue Work/Massage/Active Release Therapy (ART)
-Trigger Point Therapy
-Theragun
-Cupping
-Graston/IASTM/Scraping
-Voodoo Flossing
-Strength Training
-Range of Motion Activities
-Taping/Kinesiotaping
-Manipulation
While we specialize in treating active individuals with orthopedic and sports injuries (including post-surgical), we treat patients of all kind including: pre and postpartum women, pediatrics (8+ years old), some neurological conditions (MS, Parkinson's etc...depending on the severity), chronic pain (Fibromyalgia, Headaches...), amputations (case by case), general deconditioning.
We currently do not treat infants/toddlers or those suffering from TMJ dysfunction at this time. We also may not treat Medicare patients due to federal law.
*If you are unsure whether we treat your condition, please contact us so we can help you determine your best course of care.
No. Outpatient physical therapy services are generally covered under Medicare Part B, provided the service is considered medically necessary to treat a disease or condition. Under current Medicare regulations, it is illegal for a physical therapist to accept cash pay from Medicare patients for services that may be covered under Medicare, even if the services provided meet all treatment, documentation, and HIPAA requirements and have been prescribed by their physician
Without an evaluation, this is hard to answer. Generally speaking, the longer an injury has been going on- the longer the recovery process (though this is not always true). You should see relative improvement in symptoms or function by the 4th visit. In a traditional outpatient, insurance-based clinic where a patient is seen with 2-3 other people at a time, orthopedic patients generally require 2-3x a week. Here at Tidal Sports, we want you to GET BETTER FASTER! With one-on-one individualized care you are likely to get better with just 1-2 visits per week- saving you TIME and MONEY.
Depending on your situation, some patients find that physical therapy on a monthly basis helps keep them functioning at the level they desire and will schedule “tune ups” accordingly. This is also something that you will not see available in a traditional insurance-accepting clinic as insurance companies will deny the claims or the clinic will require you to "start-over" as a "new patient" each time. Some patients are better in 2 visits, some patients in 12. So much depends on the individual level of health, commitment to self-care, root cause of dysfunction, and how many compensations have occurred over time. It can be a process to “peel the onion”.