Insurance

  • Aetna
  • Blue Cross Blue Shield
  • Fallon
  • Harvard Pilgrim Health Care
  • Mass General Brigham (formerly Allways or Neighborhood Health Plan)
  • Medicare Part B
  • Motor Vehicle Accidents
  • Tricare (GIC)
  • Tufts Commercial Plans
  • Tufts Medicare Preferred
  • United Health Care
  • Unicare
  • Worker’s Compensation plans

These are the major insurance companies we contract with. We also contract with several smaller companies. Please call our office or click here to contact our office to verify insurance eligibility.

The most accurate way to determine all of your exact benefits is to call your insurance’s member service number on the back of your insurance card. Call that number and give them our National Provider Identifier (NPI) number which is 1932130465.

Here are some questions you will want to ask your representative:

  • Do I need authorization for physical therapy? Click here for FAQ about prescriptions and referrals (the first question)
  • If I do need authorization, do I need my PCP to put in a referral or do I need to get a prescription from my doctor, or both?
  • Are there any physical therapy services that are not covered under my plan?
  • What is my benefit year/plan year?
  • How many physical therapy visits does my plan allow me per benefit year?
  • Do I have a copay, co-insurance, and/or deductible?
  • If yes, what is my co-insurance percentage or what is remaining on my deductible?

Below is a sample bill to help you understand how to read it:

 

 

Yellow Box:

  • Service Date – The dates you came in for your physical therapy visits (also noted by purple stars).
  • Amount billed – the total amount we charged to your insurance company. You may notice that those amounts are different for some dates of service (noted by red lines). Physical Therapist have strict billing guidelines that are set by the Centers for Medicare and Medicaid as well as the American Medical Association. We bill using Current Procedural Terminology (CPT) codes. The variable amounts have to do with the services that were rendered and what insurance plan you have. We have sophisticated electronic medical records that ensure our billing is in compliance with those strict guidelines both legally and ethically.
  • Insurance payment – How much the insurance paid towards that date of service. If this amount is zero, your balance likely is due from a deductible or co-insurance.
  • Patient payment – How much you paid at each date of service and where your payments were applied.
  • Adjustment – how much your insurance adjusted the payment based on the contract between your insurance company and Orthopaedics Plus. This number will vary based on the amount billed column (noted by red lines).
  • Insurance Pending – A claim was submitted for your date of service and sent to the insurance company. If there is an amount in this column, they have not finished processing the claim. It is not uncommon for claim processing to take as little as 4 weeks and as long as 24 weeks (noted by pink underlines).
  • Patient balance – the amount you are responsible for each date of service. This amount will vary based on the amount billed and the adjustment amounts from your insurance company (noted by red lines).

Green Box:

  • Current – The amount you owe is for services within the last 30 days
  • 31-60 – The amount you owe is between 31-60 days from the dates of service and is now overdue.
  • 61-90 – The amount you owe is between 61-90 days from the dates of service and is now long overdue.
  • 91-120 – The amount you owe is between 91-120 days from the dates of service and is now extremely overdue.
  • 120+ – The amount you own is over 120 days from the dates of service and is extremely overdue, and the balance may be forwarded to a collection agency.
  • Total – The total amount you owe between all aged categories.
  • Ins. Pending – How much the insurance still has to finish processing.
  • Credit – How much credit was applied to the account, if any.
  • Total – The total amount you owe Orthopaedics Plus that is your responsibility.

Brown Arrow:

  • Description of supplies purchased from Orthopaedics Plus

Blue Arrow:

  • Highlighting the online payment option to make it easier for you to keep all balances current and not become overdue.