Billing your own Insurance

At Align Renew Thrive we have chosen to not bill any insurances. The high cost of labor and time associated with insurance compliance has become a real burden. You will have better luck if you choose to submit an Itemized Statement to your insurance for reimbursement.

MEDICARE: As we do not bill Medicare, the law prevents us from providing Medicare patients with what would be considered “normally covered services”. We can offer Medicare patients services that Medicare does not cover (including orthotics). Any service offered would not be eligible for reimbursement by Medicare. Call us today to see what we can legally offer you (541) 790-2092.

When you call your insurance:

  1. Call the phone number listed on your card

  2. Write down the name of the customer service agent

  3. Ask for OUT OF NETWORK benefits

    1. How much is your deductible and how much you have met?

    2. Do you pay a copay or a co insurance percentage for physical therapy services?

    3. Do you pay a copay or a co-insurance percentage for orthotics?

    4. Does my insurance cover orthotics?

      1. Medicare Replacement Plans – ask specifically “If Medicare does not cover this, do you?”

    5. How much is your out of pocket maximum and how much have you met?

    6. How many physical therapy visits do I have? How many have I used?

  4. Insurance Requirements

    1. Do I need a referral to be seen? (this comes from your doctor)

    2. Do I need a prescription to be seen? (different wording for a referral)

    3. Do I need an authorization to be seen? For physical therapy? For Orthotics?

      1. Get the name and phone number of the company who does the authorization

      2. Your PCP usually has all of the Diagnosis codes (DX codes) you need for an authorization (we do not have these until after we have seen you).

      3. CPT codes you may need are:

        1. 97161, 97162, or 97163 – Initial Evaluation – use 1 of the three

        2. Physical therapy codes vary – It can be any combination of these: 97110, 97112, 97140 or 97530. There are more but these are the most common.

        3. Orthotics use the code L3020 (96% of the time), they are referred to as DME – Durable Medical Goods. There are more codes but this is the most common.

We will provide you with an itemized receipt upon request.

We cannot guarantee insurance reimbursement.

Not sure what to do? Schedule a free consult