Insurance and Billing
We want getting started with physical therapy to be simple and transparent. If you plan to use insurance, here’s some information about how coverage typically works and what you can expect when you come in for your first visit.
Insurance Verification
Insurance coverage and benefits are the responsibility of the patient. We recommend contacting your insurance provider directly prior to your first visit to confirm:
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Eligibility for physical therapy services
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Copays, deductibles, and coinsurance
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Prior Authorizations and referral requirements (if any)
If you have questions about billing or payment at the time of scheduling, our front office team is happy to provide general guidance and discuss self-pay options. We encourage patients to verify benefits in advance to avoid unexpected costs.
Direct Access Physical Therapy
California allows patients to be evaluated and treated by a licensed physical therapist without a physician referral under Direct Access legislation.
This means you can begin physical therapy sooner—without waiting for a doctor’s appointment—helping you recover faster and potentially save money by avoiding unnecessary visits.
Under California law, treatment without a referral is limited to 45 days or 12 visits, whichever comes first. After this point, a physician referral may be required to continue care.
For self-pay patients and many insurance plans, no referral is required to begin treatment. However, some insurance providers may still require a physician referral in order to cover your visits. Patients are responsible for confirming referral requirements with their insurance provider.
Accepted Insurance Plans
We accept many insurance plans, including but not limited to:
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Anthem Blue Cross Blue Shield*
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Blue Shield of California
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Medicare A & B With Referral
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Railroad Medicare
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Tricare
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MedRisk
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Travelers
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Workers’ Compensation
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Self-Pay
* Anthem patients: Please contact our office to discuss in-network and out-of-network coverage, as benefits and costs may vary depending on your specific plan.
Insurance Terms
Insurance language can be confusing. Below are a few common terms to help you better understand your responsibility for care:
Copayment (Copay)
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A copay is a fixed amount you pay at each visit, determined by your insurance plan. Copays are collected at the time of service.
Deductible
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A deductible is the amount you must pay out of pocket before your insurance begins covering services. Deductibles vary widely depending on your plan.
Coinsurance
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Coinsurance is the percentage of the visit cost that you are responsible for after meeting your deductible. For example, with an 80/20 plan, insurance covers 80% and you are responsible for the remaining 20%.
Ask Us!
If you have questions about insurance, billing, or payment options, please don’t hesitate to call our office. We’re happy to help.