Make Private Pay Affordable: A Simple Guide to Using Your Insurance

by Bethany Peterson

At Well+Core Physical Therapy, we’re a private-pay, out-of-network clinic, but that doesn’t automatically mean you’re paying fully out of pocket with no help from insurance. In fact, many of our patients are pleasantly surprised to learn they can get part (or sometimes all) of their visit costs reimbursed or applied toward their deductible.

If you have out-of-network coverage, your insurance company should accept our superbills! If your claim is denied or labeled “incomplete,” contact us for options on changing your diagnostic or treatment codes. 

Let’s walk through all the ways you might be able to make private pay more affordable.

What does “private pay” and “out-of-network” really mean?

Being a private pay, out-of-network clinic simply means:

  • We don’t bill your insurance directly.

  • You pay us at the time of service.

  • You may still be able to use your insurance benefits after your visit by submitting documentation to your insurance company.

That documentation is usually called a superbill.


What is a superbill?

A superbill is a detailed receipt we create for you after your appointment. It includes:

  • Your diagnosis codes

  • Treatment codes

  • Our business information

  • What you paid and when

You send this superbill to your insurance company, and they review it based on your out-of-network benefits.

If you have out-of-network coverage, your insurance will likely reimburse you for part (or even all) of your visit costs. In some cases, your insurance company may notify you that certain treatment or diagnosis codes are “incomplete” or “not accepted.” In that case, you can contact us directly to change diagnosis or treatment codes. 

Even if you don’t receive direct reimbursement, those payments often apply toward your deductible, which can help you reach it sooner.

At Well+Core, we can provide superbills for most commercial insurance plans.

Please note: we are unable to provide superbills for Medicare Part A or B plans.


How reimbursement usually works (step-by-step)

Every insurance plan is different, but here’s the general flow:

  1. You pay for your visit at Well+Core at the time of service.

  2. We give you a superbill after your appointment (or on a regular basis if you prefer).

  3. You submit the superbill to your insurance company (often through their app, online portal, or by mail).

  4. Your insurance processes the claim using your out-of-network benefits.

  5. One of two things normally happens:

    • You receive a reimbursement check or direct deposit, or

    • The amount you paid is applied to your out-of-network deductible.

Either way, your visit may be helping you financially more than you realize.


Why your deductible matters (especially if you’ve already met it)

If you’ve already met, or are close to meeting, your deductible, this is extra important.

  • If your deductible is met, your insurance may reimburse a larger portion (sometimes most or all) of your visit costs.

  • If you’re still working toward your deductible, your Well+Core visits may help you get there sooner, especially when the payments are applied to your out-of-network deductible.

This is one reason it’s worth taking a few minutes to call your insurance company and ask about your benefits. Those few minutes can translate into hundreds of dollars of savings over a plan year.

 

Using HSA and FSA funds for your visits

Another way to make private pay more affordable:

We accept HSA (Health Savings Accounts) and FSA (Flexible Spending Accounts) for payment.

That means you can:

  • Use pre-tax dollars to pay for your visits.

  • Reduce your taxable income while taking care of your health.

  • Often stretch your budget further than you could with post-tax income.

If you already have an HSA or FSA card, you can usually use it just like a debit card at the time of your appointment.

 

Questions to ask your insurance company

If you want to know exactly what’s available to you, here are some helpful questions to ask your insurance provider: 

  1. Do I have out-of-network benefits for physical therapy?

  2. What is my out-of-network deductible, and how much of it have I already met?

  3. What percentage of the visit will you reimburse once my deductible is met?

  4. Do you reimburse based on the provider’s billed amount or a predetermined “allowed” amount?

  5. How do I submit a superbill? (Online portal, app, fax, or mail?)

  6. How long does reimbursement typically take?

You don’t have to have all of this memorized, just jot these down or screenshot them and keep them handy when you call!

How Well+Core makes it easier

We know navigating insurance can feel overwhelming, and we don’t expect you to do it alone.

If you’d like to learn more about using your out-of-network benefits, whether you might qualify for reimbursement, or how to request a superbill, please reach out to our office admin, Blaire. You can reach her during office hours via email: admin@wellcorept.com or via phone/text: 913-303-0978

You deserve high-quality, specialized care, and we’re here to help you access it as affordably as possible.

If you’re ready to schedule your appointment, you can do that here. 

 

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