Insurance Processing & Billing Solutions
Thank you for choosing Tristar Physical Therapy as your physical therapy provider! We understand that the cost of medical services can sometimes be confusing, and our goal is to make the billing process as clear, simple, and transparent as possible.
Charges
Tristar Physical Therapy will file insurance claims on your behalf. Depending on your health insurance benefits, the costs for services may vary. We also offer Self-Pay (Cash) options for those without insurance coverage or who prefer to pay directly.
For plans with a deductible, we typically collect $50 per visit to apply toward your overall balance. Please note, this amount is not a single payment for that visit, but rather contributes to your total Plan of Care. Collecting these payments throughout your treatment helps reduce the likelihood of a large bill at the conclusion of your services.
*For Aetna and Blue Cross plans, patients may have additional out-of-pocket responsibility for the initial evaluation as well as any follow-up re-evaluations.
*Any unused credit will be refunded once your treatment plan is complete.
Patient Cancellation Policy
After a second no-show or cancellation within 24 hours of your scheduled appointment, a $50 fee will be applied. Please review our full policy here
Patient Account Credit
If you have a credit on your account, it will automatically be applied to your upcoming visits until your treatment plan is finished.
Treatment & Fee Overview
Initial Evaluation: For patients with unmet insurance deductibles, the cost is typically around $150.Follow-Up Appointments: For plans with unmet deductibles, the average cost is around $90.Co-Insurance:- 90/10 Plan: When the patient is responsible for 10%, the estimated cost is approximately $5–$15 per visit.
- 80/20 Coverage: When the patient is responsible for 20%, the estimated cost is approximately $10–$25 per visit.
Self-Pay Information- Initial Evaluation: $160 for self-pay patients.
- Follow-Up Appointment: $95 for self-pay patients.
- Post-Operative Follow-Up Appointment: $75 for self-pay patients.
Automatic Monthly Billing
For your convenience, Tristar Physical Therapy offers an automated payment process at each location, including automatic per-visit charges and end-of-month billing. Your credit card will be securely stored in our system and processed at each visit, with any remaining balance billed at the end of the month (on the 25th or the next business day).
For patients enrolled in end-of-month billing, any remaining balance will be charged at the end of the month once insurance claims have been processed.
Please note: Claims processing can take approximately 6–8 weeks.
We encourage you to speak with your Clinic Coordinator to see if this option is right for you.
Insurance Carriers We Work With
We work with all major insurance carriers and many more, making it easy for you to focus on your health
- Aetna
- Auto Insurance
- Blue Cross Blue Shield
- Cigna / ASH
- Medicare
- Humana
- Tricare
- Veterans Affairs Community Care (VA)
- Workers Compensation
Billing Process Overview
Validation and Submission Process
When you schedule your first appointment, we will collect your insurance information to get started. As a courtesy, our team will contact your insurance provider to verify your coverage and clearly explain your benefits to you before your initial visit, ensuring full transparency and no surprises.
We also recommend that you reach out to your insurance carrier directly before your appointment to better understand the physical therapy and/or occupational therapy benefits available under your medical plan.
Following your visit, we will take care of submitting all insurance claims on your behalf. This means you won’t need to worry about additional forms or paperwork, allowing you to focus entirely on your care and recovery.
Our physical therapy billing process is very similar to a typical doctor’s visit. When you receive care, the following happens behind the scenes:
- The physical therapist submits charges to your insurance provider, Workers’ Compensation carrier, or directly to you based on standardized Common Procedural Terminology (CPT) codes used to describe the services provided.
- These codes are entered into a billing claim, which is then submitted to the payer either electronically or by mail.
- The payer reviews and processes the claim and issues payment according to the agreed-upon fee schedule.
An Explanation of Benefits (EOB) is then generated and sent to both you and the physical therapy clinic. This statement outlines the services covered, the amount paid by the payer, and any remaining balance that may be your responsibility. - If a balance is due, the patient is responsible for submitting payment for that remaining amount.
*It is important to understand that the billing process involves many additional steps beyond the outline provided above, and exceptions are common. At various points in the process, information may be missing, miscommunicated, or misunderstood, which can result in delays in payment. While most claims are processed and paid within 60 days or less, it is not unusual for a physical therapy clinic to receive payment up to six months after the date of treatment.
Issuing Statements
At the beginning of each month, we send out a statement showing your account activity from the previous month. It includes your dates of service, payments you’ve made, payments from your insurance or other payers, any claims still being processed, and the portion of your balance that is your responsibility.
Any balance due should be paid within 10 days of receiving your statement—or by the 25th of the month, whichever comes first. This balance reflects the portion of your bill that your insurance does not cover, such as deductibles or co-insurance. Once your insurance processes your claim, we receive an Explanation of Benefits (EOB) showing what was paid by your insurance and what portion remains your responsibility. Any unpaid amount from your insurance will be added to your patient balance.
If your treatment dates fall across two different months, your first statement may only include visits from the first month, along with the corresponding balance due. Please make sure to pay each statement when you receive it.
You’ll receive a statement anytime there is a balance on your account.
For your convenience, payments can be made online, mailed in with your statement, or called in to our office. We accept all major credit cards and checks. If you have any questions about your statement, our team is always happy to help.
Outstanding Accounts
We regularly review all accounts. If a patient account has a balance over 90 days and there is no outstanding insurance claim, it may be sent to a third-party collections agency. Before any account is sent to collections, we will make every effort to contact you with courtesy calls or emails.
Insurance Terms Explained
Premium: This is the monthly payment you make to have health insurance. Think of it like a gym membership—you pay the premium every month, even if you don’t use your insurance, or you could lose coverage. If you have employer-provided insurance, your employer often covers all or part of the premium.
Copay: A copay is a fixed amount you pay for a health care service at the time you receive care. For example, you might pay $25 for a visit to your primary care doctor, $10 for a monthly prescription, or $250 for an emergency room visit.
Deductible: Your deductible is the amount you must pay out-of-pocket for care before your insurance begins covering more of the cost. For example, if your deductible is $1,000, you pay the first $1,000 of your care yourself. Deductibles typically reset each year.
Coinsurance: Coinsurance is the percentage of a medical bill you pay after your deductible is met, with your insurance covering the rest. For example, if your coinsurance is 20%, you pay 20% of each bill and your insurance pays 80%.
Out-of-Pocket Maximum: This is the most you’ll have to pay in a year for your health care before your insurance covers 100% of the costs. Once you reach this limit, you won’t owe anything more for covered services for the rest of the year.