Physical Therapy Insurance Coverage

We are currently in network with all of the following insurance providers:

• AARP
• Aetna
• BC/BS/Anthem/Federal
• City of Milwaukee
• Comp Care
• EBG Employees Benefit Group
• FHC
• Great West/Great Midwest
• Health EOS/Multi Plan
• Humana
• Medicare/Medicare Railroad
• Milwaukee Carpenters
• NPPN
• Operating Engineers
• PHCS Private Health
• Principle
• TRI Care US Navy
• Trilogy Health/Trilogy Health Network
• UHC United Healthcare
• UMR
• US Dept. of Labor
• WEA
• Workers Compensation
• WPS WI Physician Services
• other independent insurance groups

To make dealing with your insurance as painless as possible, our staff will verify physical therapy benefits covered by your insurance plan and we will share this information with you. If you want to find out if we are in-network with your insurance carrier before you call us, you may have to look for us as Preferred Rehabilitation and Orthopedic Care, which is our legal name. PROCare Physical Therapy is contracted with most major insurance companies. PROCare PT is a Wisconsin Worker's Compensation and a Medicare approved facility.

In order to minimize your physical therapy costs, our staff will follow the guidelines set forth by your health insurance plan. We will bill your primary and secondary insurance before billing you.

Many patients choose to privately pay for their physical therapy services, without billing health insurance.  For these patients we have a couple options.  We offer a "flat rate", per visit fee or "private pay packages" both of which represent rates typical of what we would be reimbursed by insurance for our services.

Patients choose these options for various reasons.  Private pay allows a patient immediate access to physical therapy services, affordability for those with high deductible insurance policies, access to high quality services when facing "out-of-network" benefits coverage, no time restrictions or visit limits (as set by many insurance policies), just to name a few reasons.

Please contact us if you would like more information about these options.

If you ever have any questions or concerns regarding your bill, our Patient Representative will be available to find answers for you.

Insurance Benefits Terminology

If you have a deductible:

This is an amount that is required to be paid by a subscriber (patient) per your personal insurance plan, before health plan benefits will begin to reimburse for services. It is usually an annual amount of all health care costs that is not covered by your insurance plan. Deductibles typically run from $100 to $5,000.

For example, if a patient has a $1000 deductible, he/she is responsible for the first $1000 in health care charges for the year. After that, the coverage would be split according to your insurance plan formula.

If you have a co-insurance:

A co-insurance is a percentage determined by your insurance plan that you the patient will be responsible for, once the insurance has processed your claim. For example, if your coverage is 90/10, you are responsible for 10% of the allowed charges.  Co-insurance typically does not apply until after a patient has satisfied their deductible.

If you have a co-pay:

A co-pay is a set dollar amount determined by your insurance plan that is due at the start of each visit. According to your plan you may still owe a balance for co-insurance.

Other insurance issues that you may need to know:

• Some insurance plans will have a "Maximum Dollar/Visits Amount" which means that they will only pay a certain dollar amount or a limited number of visits per diagnosis or per year. If you were treated at another facility this year, this would affect your "maximum" so please inform us. Insurance companies will not always give us that information.
• If your insurance carrier denies your coverage, all bills for services provided will be your responsibility.
• We are not always able to give you an exact figure that you will be charged for physical therapy before your appointment. This figure will vary depending upon the therapist's evaluation of your condition. The charge for each visit will be determined according to your therapy needs.
• When we verify your insurance benefits, we are told of coverage only and may not be made aware of certain non-covered services. We will never knowingly bill you for a non-covered service.
• Even when a policy says that you are 100% covered, there may be some non-covered services which cannot be predetermined.