What is the difference between Co-insurance & Co-pay?

A co-insurance is a percentage determined by your insurance plan that you, the patient, will be responsible for once the insurance has processed your claim. For example:

“Let’s say your coverage is 80/20 which means you are responsible for 20% of the allowed charges. Therefore, if we ask you, the patient, to pay $25.00 at each visit the $25.00 will be applied to your ending balance, which is undetermined until your insurance processes, your claims.”

Co-pay is a set dollar amount determined by your insurance plan that is due at each visit. For example:

“If your insurance plan requires you, to pay $15.00 co-pay at each visit this will be due at each visit.”

Will the money I pay upfront at every visit cover all my expenses towards my balance?

The money you pay at each visit is a portion going towards your ending balance, and it will not cover all of your expenses. The money you pay at each visit goes towards your ending balance and decreases the total amount you will have to pay in the end. This is a way to decrease the chance of having a financial burden on you and your family after you have completed treatment.

Will I be responsible for any services my insurance denies?

Yes, all services provided must be paid in full by either your insurance plan or yourself.

Is there a maximum dollar amount that my insurance plan will cover?

Some insurance plans will have a maximum that they will pay towards your therapy.

If you were treated at another facility before being treated at ARMD what you should you be aware of?

We will require for you to notify us upfront if you are receiving therapy services at another facility, some Insurances such as Medicare, Medicaid will not cover for services if you are being treated at a Home Health or other private Therapy place. You need to be discharged from these services in other to utilize our services.

I thought my insurance covered everything 100%?

There may be services which are non-covered under your plan which can’t be determined until your claims have been processed by your insurance company.

How much time do I have to pay my portion of the bill off once treatment is completed?

You can contact our Billing Office to discuss all available payment options.

Motor Vehicle Accidents

Being involved in a motor vehicle accident is traumatic; we are here to help answer all of your questions.

Please call us at (928) 782-5588

What does third party insurance or liability mean?

If we are given the information for that Insurance Company, we usually mail a Lien to them, and if you give your authorization they will cut us a check upon time of settlement.

What is a lien/letter of protection?

A lien is voluntary and is basically a promise by the patient to protect our interests in the event of a settlement. A letter of protection is a document that we receive from your attorney, stating that he/she will protect our interests at the time of settlement. Your attorney will need your authorization to give us this letter so he/she can pay us out of the settlement proceeds.

Do I have to pay anything on my bill if there is an attorney involved?

Due to the Statute of Limitations, which varies from state to state, litigated accounts may take up to 2-3 years to get settled. Therefore we ask you to make minimum monthly payments to keep your account current. Payments are due until the case has settled or the account has been paid in full.

Why is it important for me to give out additional insurance information?

We will make all possible attempts to get your account paid in full, and leave you with minimal out-of-pocket expense. It is to your benefit to supply us with all the necessary information to avoid future problems and to quicken the process.

How will I know if owe a balance?

You will receive a Monthly bill to make you aware of the status of your account.

What is a Therapy Cap?

The therapy cap places an annual limit on the total dollar amount Medicare will reimburse for each beneficiary’s rehabilitation services.

The cap amount is:

$1,980 for Physical and Speech Therapy (combined)
$1,980 for Occupational Therapy

The cap does not reset for each diagnosis; so, even if a patient seeks therapy related to multiple diagnoses over the course of the benefit period, all of those services would count toward that patient's $1,980 limit. Still, to ensure the cap does not prevent Medicare patients from obtaining medically necessary care.

What is an Advance Beneficiary Notice (ABN) of Non-coverage?

An Advance Beneficiary Notice (ABN) of Non-coverage allows a patient to keep receiving therapy that is no longer medically necessary. Essentially, an ABN notifies a Medicare patient that Medicare might not cover the therapy services he or she is about to receive and serves as proof that the patient understands his or her financial obligation. By signing an ABN, the patient agrees to pay for treatment out-of-pocket or through a secondary insurance.

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