Attendance Policy: We require a 24-hour cancellation notice, as time has been set aside specifically for your appointment. We understand emergencies and extenuating circumstances may occur, which is why we ask for 24 hours to cancel or work with you to reschedule your appointment. In the instance of a cancellation under 24 hours, or a no-show to a scheduled appointment, we reserve the right to charge a $25 fee.
Financial Policy: We verify your insurance as a courtesy to you, however it is ultimately your responsibility to understand your insurance coverage and benefits. A quote of benefits is not guaranteed payment, and coverage is subject to change upon claims processing. At the time of service, you are responsible for paying all deductible/coinsurance/copayments for all services provided. This is a legal requirement when receiving any healthcare services. Failure to meet these requirements is a violation of the agreement with your insurance carrier and federal law. If your insurance carrier does not cover services billed, you are responsible for payment at the self-pay rate.
Insurance Referrals: Your insurance plan may require a referral from your Primary Care Physician (PCP) prior to the start of receiving physical therapy treatment. As a courtesy, we will request a referral from you PCP. Ultimately, it is your responsibility to provide that PCP referral to be compliant for receiving Outpatient Physical Therapy Services coverage. If your insurance denies payment due to PCP referral not on file, we reserve the right to bill you at self-pay rates: Evaluation: $150 Follow up: $65
Release of Information/Benefit Assignment: I hereby assign all medical benefits, including major medical benefits to which I am entitled under Medicare, Private Health Insurance, Med Pay, PIP and Third-Party Payers, payable directly to Peak Physical Therapy, LLC for any and all services rendered to me and billed on HCFA1500 forms on my behalf. A copy of this assignment is considered as valid as the original. I hereby authorize Peak Physical Therapy, LLC to release any and all information necessary required in the billing process to facilitate and secure payment for medical expenses incurred.
Treatment Consent: I give my consent for Peak Physical Therapy, LLC to provide me with necessary medical care and treatment for diagnosing and treating my condition. I understand that I am requesting these services at my discretion. I am responsible for communicating all important information to my therapist and office staff, as may be required for the individual needs of my treatment plan and billing process.