Medicare Patients: As of January 1, 2006 Medicare has a dollar amount cap for outpatient Physical Therapy benefits. Your supplemental plan may provide coverage beyond this cap. It is your responsibility to be aware of the remaining benefits under Medicare. This waiver is an acknowledgement that you are aware of the Medicare cap and that you are responsible for paying the balance on any visits that Medicare or your insurance does not.

Workers Compensation Claims/Self-insured Claims: Please provide the office the name and phone number of your claims representative before you begin treatment. We request your private insurance information at the time of service. If your L&I claim is not accepted we will bill your private insurance. You are responsible for payment of services rendered if your claim is not accepted.

Motor Vehicle Collisions: We will bill your Personal Injury Protection (PIP) as a courtesy to you. However, you are fully responsible for the bill. In the even that payment has not been made within 30 days, you will be required to make payment arrangements.

Private Pay/No Insurance: Full payment is due at the time of service.

Doctor Referrals: You are responsible for obtaining a referral and/or prescriptions from your primary care physician prior to your appointment. It is your responsibility to make sure we have a valid and current copy of your referral/ prescription in the office at the time of your appointment. Exceptions to this policy are plans that have direct access to therapy with no referral required.

Cancelations and No Show appointments: If you are unable to make your scheduled appointment we ask that you contact our office to cancel your appointment. If appointments are canceled with less than 24 hour notice there is a $50 cancellation fee that will be the patient’s responsibility.

Payment Issues: Please contact our billing department as soon as possible if financial problems arise. If an account becomes past due, necessary action will be taken, up to and including collections and legal action.