Performance Therapies, PC appreciates the confidence you have shown in choosing us to provide your rehabilitative needs.  It’s our goal to provide high quality care at a reasonable cost, while still providing full service, such as billing directly to your insurance company on your behalf.  It is a service that you have elected to participate in, which implies a financial responsibility on your part to Performance Therapies, PC.

Your Responsibility
You are financially responsible for the services we provide to you.  We understand that many patients have insurance that pays for a large portion of their medical claims.  However, the patient (or legal guardian if the patient is under 18) is ultimately responsible for the bill if the insurance company does not pay.  We will try to provide you with the information we receive from your insurance company regarding your insurance benefits for physical therapy.  This information will be provided to make you aware of your potential financial liability for your services.  (Please be aware that this information is what was provided to us by your insurance company at your initial evaluation and may change by the time the claims are submitted and processed.) If you would like further explanation of these benefits we advise you to call your insurance company directly.ter insurance has paid their part of the covered portion will be due upon receipt of a bill.

• Patients without Insurance
  Performance Therapies, PC is pleased to be able to provide services to patients that do not have insurance.  You will be asked to speak to our financial counselor to discuss payment of your services.
• Liability Insurance/Personal Injury
  If you are involved in an accident we will be happy to provide medical care for you.  In most cases we will file claims with a third-party liability insurance plan.  If there is a chance that your injury may end up in litigation, we will look to you for payment.  We will not carry the balance until the case is settled.  You will need to speak to our financial counselor if you need to set up payment arrangements.
• Workman’s Compensation
  If you were injured at work and filed a claim with your employer, your employer’s workman’s compensation insurance company will pay the entire amount of your care.  You will need to provide us with a contact person and phone number of your employer or the name of the insurance carrier, their address and your claim number in order for us to bill your claims.
• Traditional/HMO/POS/PPO Health Insurance
  There are many different types of insurance plans out there.  We are not able to know the specifics of each and every plan.  Feel free to call us and/or your insurance representative to find out if we are in network for your plan, and what your physical therapy benefits and/or limitations are in an office setting.  We will bill your insurance company directly for you.  We will look to you for any remaining portion that your insurance company will not pay to be paid at the time of service.  (%, co pays, deductibles)  If you have a secondary private insurance plan available we are usually able to bill that insurance for remaining amount.
  
• Medicare
  We are participating providers with Medicare and will bill directly for you.  You are responsible for the Part B deductible and the 20% coinsurance.  Performance Therapies, PC agrees to accept Medicare’s fee schedule.  If you have a secondary insurance (Medicare Supplement or other indemnity plan), we will bill them for the 20% and wait for payment.  If not, you are responsible for the remaining amount. Please discuss with our office the current Physical Therapy cap amount.
• Iowa Medicaid/Medipass
  Performance Therapies, PC accepts Medicaid/Medipass assignment.  A current Medicaid card must be presented at each visit and you will be responsible for any co pays at the time of service.
• Returned Check Policy
  There will be a $30 charge for all check returned as non sufficient funds.