Rates And Insurance

All of your treatment sessions are booked with a skilled, licensed and nationally accredited physical therapist who also has advanced certifications in spine and scoliosis disorders. Each session is a one-on-one, hour-long appointment. Our rates for treatment sessions and other services vary depending on what the specific needs of your program will be, so please call us at (512)629-4431 to enquire about pricing.

We are considered a “fee-for-service” clinic which means that we are not “in-network” with any insurances however, if you have out-of-network benefits, we are able to provide you with a justification letter that will outline how our services differ from any other therapy services that are in your network (Known as a GAP form) so that you insurance may consider us “in-network” when providing reimbursement for you. Upon request, receipts for each session can be provided to your that will include the necessary codes and treatment information to self-submit your claims to your insurance company.

*** We have provided additional information below that may be helpful for you in this process so, please continue reading on how the changes in many health insurance plans and deductibles have sometimes made it cheaper not to use your insurance for some physical therapy services, especially if you have high copays or deductibles.

Did I read that right? Can not going directly through my insurance possibly save me money?

In short, over the years, it has gotten very difficult for physical therapists to treat how they would like. Many insurance companies strongly influence the treatment that patients receive at “in-network” clinics (by how many visits they will authorize) and, as a profession, we have seen a continued reduction in reimbursement rates for the skilled treatment provided by our therapists. This often means that, despite our therapists becoming better, more educated and highly skilled, the reimbursements are getting less and less. This is often why you end up at a physical therapy clinic that must see 3-4 patients an hour to make ends meet, using assistants to carry through your treatment and performing exercises and “therapy” with bands and weights that you can often do on your own at home. At ScolioAustin Scoliosis and Spine, we refuse to believe that is in the best interests of our patients and since we are here for you, we refuse to play the insurance company’s game of dictating the quality of our treatment.

The more convoluted (but we will try to be quick) answer is:

Insurance companies do not acknowledge specializations in the field of physical therapy. It doesn’t matter whether you have a session with a new graduate, with little clinical experience, or a 30 year-veteran, who has spent years and thousands of dollars honing their unique skill set, educational advancement, and expertise. All physical therapists are required to bill the same codes regardless of the uniqueness of treatment you might be receiving. And these are being reimbursed equally poorly to all of us making it difficult for many small businesses to survive. Furthermore, these “in-network” clinics tend to require patients to attend 2-3 appointments per week to make sure they are maximizing their reimbursements.

What does being Out-Of-Network mean?

We are an out-of-network practice because the “in-network” business model of using aides and seeing multiple patients per hour does not allow us to provide the superior, unique, and personalized services that are key to our practice mission. Additionally, as our therapists are among an elite group of specialized orthopedic and scoliosis therapists, trained in advanced orthopedic and scoliosis certifications, they are providing specific (not cookie-cutter) programs and manual therapy different from traditional PT clinics.

At ScolioAustin Scoliosis and Spine PT, we do not believe that modalities (such as ultrasound, heat packs/cold packs and muscle stimulation) are an effective or time appropriate way for our patients to spend their time. Our uninterrupted, hands-on treatment and skilled manual therapy experience provides patients with a much more effective and efficient carry-over to independence, with fewer sessions, than patients who are paying to perform therapy band or weight exercises at the clinic that they could find on YouTube. All our patients receive undivided care, hands-on treatment and specifically designed exercises for an hour from a skilled, licensed and advanced-Schroth credentialed physical therapist which means that our plan of care has the most efficiency when seeing the majority of our patients only once a week.

Need more convincing?

Do you need more convincing?
When you consider the time and energy saved by having fewer trips to our office, unique education about your body that can’t be provided by traditional PT and the value of creating independence sooner, thus reaching your goals so much faster than average, the out-of-pocket expense at ScolioAustin Scoliosis and Spine is a huge bargain. Additionally, with some insurances, the out-of-pocket expense paid for our treatment sessions, is often less than patients would pay at a clinic that accepts their insurance, especially if you’re making time and dropping co-pays 2-3x/week. Remember that, in the past years, deductibles and copays have skyrocketed. If you have a high co-pay or deductible, traditional PT clinics may charge you 2-3x the amount you’re paying at our clinic s just to meet your deductible. Additionally, you usually won’t start receiving those $200+ bills until you’ve been receiving care for 6-8 weeks and, by then, you have already racked up an enormous balance. So before deciding on where to get PT based solely on which clinic “takes your insurance,” make sure you know how much you’ll be paying at your in-network options and what quality of service you’ll be paying for.

If you’d like to talk with us further about this, please don’t hesitate to reach out to us at 512-629-4431 or scolioaustin@icloud.com.

Ask Yourself These 5 Crucial Questions:

Most people are quite unaware of the games their insurance companies play in order to pay out as little as possible and maximize their profits. So, as you weigh your options for physical therapy care, ask yourself a few questions (courtesy of Drjarodcarter.com):

1. Ask your insurance company what percentage of the total physical therapy bill will be your responsibility if they are an in-network clinic (especially if you still have a deductible to meet). If you are expected to pay 100% of the bill until you’ve met your deductible, ask the prospective PT clinic the amount of the average bill sent to an insurance company. This means that PT clinic’s amount on the bill … NOT what the insurance company has agreed they will pay the clinic). In most cases, you will ultimately be paying the full bill until your deductible is met.

2. If you have met your deductible, ask how much your copays will be? Ask how many times per week the average patient is asked to come in for treatment.

3. Consider the quality of care you’ll be receiving at your various options, and how much value you place on receiving higher-quality, one-on-one care from a specialized Schroth physical therapist rather than a PT Assistant (PTA), an unskilled “tech” or an traditional PT untrained in the specifics of scoliosis. Would you go to a Pelvic Floor specialist if you had a total joint replacement?

4. Consider how often you’ll be missing work and/or time with family to attend your PT sessions. Again, you can ask any prospective clinic how many times per week their average patient is asked to come in for treatment.

5. Consider whether you have just one deductible or if you have both an in-network deductible and an out-of-network deductible. If you have two deductibles, then claims from an out-of-network clinic like ours will not apply to your in-network deductible unless we can get a GAP form approved to have our clinic viewed as an “in-network” provider since there are no other specialists like ours in Austin.

In Conclusion: If you ask the above questions and do the math, you may be quite surprised at what you find!

With all the above information, you can now get a real sense of what your true costs will be, what level of care you’ll be getting, and then make the best decision on where to receive your physical therapy treatment.

CAN I BILL MY INSURANCE FOR REIMBURSEMENT OF MY OUT-OF-POCKET EXPENSES? (general information courtesy of Drjarodcarter.com)

This depends on the insurance you have, but YES, most NON-Medicare patients can send “self-claims” to their insurance company for their treatments at our clinic. You should be able to print claim forms off your insurance company’s website and send it in with the receipts and justification letter provided to you by our clinic. The amount of reimbursement or application towards your deductible is completely dependent on your insurance plan. When you call your insurance company to inquire about what you can expect to receive, you should ask about reimbursement for “out-of-network Physical Therapy” expenses sent in via self-claims as well as a GAP form which means the insurance company is recognizing the uniqueness of our facility and that you cannot get our services at any other facility in your usual list of “in-network” providers.

Medicare (information provided by Drjarodcarter.com)

Medicare Beneficiaries: The US government has some interesting laws that control where Medicare beneficiaries can spend their healthcare dollar and persuade healthcare providers to enroll in their system. Because we are not Participating Medicare Providers, we can only accept Medicare beneficiaries as patients when the patient does not want Medicare billed for any PT services. This request to not involve Medicare in payment must be made up front by the patient and be made of the patients own free will. In other words, if you’re a Medicare beneficiary and are adamant about seeing us for your care even though we are not participating Medicare providers, we can help… However, the only way we can provide you with PT services is when you truly don’t want Medicare involved and you ask up front that Medicare not be billed or involved in your physical therapy care.

If you do want to use your Medicare benefits for physical therapy, we cannot provide you with treatment at our clinic but we can help you find a good Medicare provider in your area.