Insurance Information

couple filling insurance form

Financing

A variety of options are available to help you finance the cost of therapy:

Flexible payment options:

Care Credit: https://www.carecredit.com/doctor-locator/

  • Good to average credit
  • Fixed rate loans with no prepayment penalty
  • Interest-free if balance paid in full in 6 months
  • Monthly payments as low as $125 a month
  • To apply, call 1-800-365-8295 or click the link above to complete an online application.

We recommend checking your spam/junk email folder to ensure that you do not miss any communications from your selected finance company.

Insurance (U.S. Patients)

Our clinics address pain, adhesions and micro-adhesions that cause pain and dysfunction. We treat the adhesions with the goal of decreasing pain and increasing function as quickly, efficiency and thoroughly as possible . We provide physical therapy (PT) services. U.S. based physical therapists are licensed by the state to treat pain and dysfunction. While we are out of network providers, you will pay us directly for our services. However, your insurance company may reimburse you for part or all of your therapy, especially if you have complaints of pain. We will give you copies of all paperwork, including your initial evaluation, daily notes, an itemized billing statement and a letter from our therapists to your insurer stating why they should cover 20 hours of “out of network” physical therapy. Medicare and Medicaid do not cover our level of service. Our procedure codes are defined and approved by the American Medical Association and include the following common PT codes:

  • 97161 – Initial Evaluation (Low Complexity)
  • 97162 – Initial Evaluation (Moderate Complexity)
  • 97163 – Initial Evaluation (High Complexity)
  • 97164 – Re-Evaluation
  • 97110 – therapeutic procedure
  • 97112 – neuromuscular reeducation
  • 97140 – manual therapy
  • 97530 – therapeutic activities to increase function
  • 97535 – self care instruction

We recommend contacting your insurer and asking about reimbursement before scheduling therapy. We suggest asking about:

  • Your “outpatient physical therapy benefits” — We are considered an “out of network” provider for you. If you are seeking our therapy for treatment of pain or adhesions, tell your insurer that you will be receiving “physical therapy treatment for pelvic adhesions” or “physical therapy treatment for pelvic (or other) pain.”
  • Whether you need preauthorization — If so, your doctor’s office needs to contact your insurance company for an authorization number, which you will keep for your records.
  • Whether you need a physician’s written referral — If so, have your physician use our referral form or write on his/her prescription pad “physical therapy for treatment of abdominal adhesions (or pain).” If you are coming for the accelerated five-day program, it should specify “20 hours of therapy over five days.” S/he should sign, date, provide their NPI # and give you the note.

Accelerated program clients should tell their insurer that they will be receiving several hours of therapy a day (usually 4 hours a day for 5 days = 20 hours of therapy). Twenty hours of physical therapy per year falls within the parameters of most insurers, but some try to limit subscribers to one hour of therapy a day. Explain that this is a special case, that Clear Passage® is one of the few clinics in the country with published results treating adhesions and/or pelvic pain without the risks of surgery or drugs. Remind them that therapy is much less expensive than surgery (which can easily cost $20,000 or more, with anesthesia and hospital surgery room charges). In addition, the U.S. Department of Health & Human Services’ Agency for Healthcare Research and Quality reports that the average cost of a laparoscopy is $44,500, while the cost of lysis (removal) of adhesions is $61,900. In 2010, the average cost of small bowel resection surgery was $114,175; including 14.2 days of hospitalization (average) and 1 of 15 people died before discharge from the hospital. Ask to speak with a supervisor, if necessary. Always record the name, time and date of the person with whom you speak.

Documents That May Help Reimbursement

  • Patients with Pain: Insurance Suggestions and Documents for Patients with Pain, click here.
  • Patients with Bowel Obstructions: Insurance Suggestions and Documents for Patients with a History of Bowel Obstruction, click here.
  • Insurance appeal letter for bowel obstruction patients: click here.
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