Do I need a referral to see you?
No! Colorado is a direct access state meaning that your physical therapist can be your first point of contact when you have a concern. This can save you the time and money of having to see a physician first, and can often lead to improved outcomes with quicker treatment. As Doctors of Physical Therapy, we are highly trained to screen for circumstances that would warrant imaging or further assessment from a physician and will promptly refer you to the appropriate places when necessary. Some insurance companies do require a physician referral, so if you plan on submitting claims to your insurance company for reimbursement, this would be a question to ask your insurance provider. If you are a Medicare recipient, you will need a physician referral prior to seeking physical therapy services. Since dry needling, Pilates, and wellness visits are not covered services under Medicare, you can see us for those things without a referral.
Do you take my insurance?
We are a participating provider with Medicare at this time. For other insurances, we are an out of network provider, similar to many chiropractors or massage therapists. However, we are happy to provide documentation to submit to your insurance company for reimbursement and help you navigate that process. We do this for a few reasons. First, operating on a private-pay basis allows us to design a program based on what is most appropriate for you and not influenced by what insurance companies mandate. Second, this allows us to focus all of our energy on providing you exceptional care and not on dealing with the administrative burden that comes with processing insurance.
You say that even as a private-pay provider you may be less expensive than an in-network provider?
YES! First of all, there is a good chance that you can get your sessions partially or fully reimbursed by submitting an itemized receipt that we will provide to your insurance company. And regardless of that, with more individualized and focused care, our expectation is that we will need to see you less frequently and in less visits overall to get you feeling better compared to traditional physical therapy providers. Compared to other clinics, it is unlikely you will need to come in more than once per week and during each visit, you can expect our undivided attention for a full 60-minute session. This saves you time out of work, having to pay high co-pays over and over again, and the overall amount of money spent across the duration of your treatment. Even if you pay a smaller amount each visit in traditional systems, that is going to add up to a greater overall amount if you have to go to more visits than is necessary. Plus, if you have a high deductible through your insurance, until that is met you are responsible for 100% of the cost anyway. At Spire Physical Therapy & Wellness, we keep our rates lower than standard therapy charges to ensure the burden of getting back to a healthier lifestyle is manageable for you. (For an example of how this might play out, check out our pricing page.)
How do I know if I have out of network benefits with my insurance provider?
This is as easy as calling your insurance company and asking them if your plan includes out of network benefits. If it does, it will be helpful to ask some follow-up questions to make sure the reimbursement process goes smoothly. These include:
- Do I have an out of network deductible?
- Have I met my deductible for the year? If not how far away am I from meeting the deductible?
- Is there paperwork that must be filled out when submitting the out of network claims? If so, do you provide that paperwork?
- Do I need to be pre-certified for physical therapy sessions in order to receive reimbursement?
- Do I need a physician referral to physical therapy for reimbursement of services?
Other questions?? Contact us now!