Billing and Insurance

Bringing Quality Back to Physical Therapy

Patient-Centered Care

IPA Physio operates as an out of network provider because of our mission to provide the highest quality
methodical physical therapy. The increasingly restrictive medical business model necessary for an “in-network”
insurance-based PT practice is not aligned with our mission and it does not support our patient-centered
Functional Manual Therapy (FMT) Treatment Model.

Selecting IPA Physio as your physical therapy provider is a choice for higher quality of care, and it can
actually save you money! Watch our video and read the information sections below. Call us with any questions.
We want you to make an educated and informed decision about where to seek physical therapy.

Direct Access & Your Patient Rights

In California (and all 50 states), patients have the right to seek treatment from a licensed physical therapist without a prescription or referral from a physician. Treatment can continue for a period of up to 45 calendar days or 12 visits, whichever occurs first, after which time the patient must receive a prescription from a Medical Doctor (or other equivalent personnel). This means that a patient can come to IPA Physio OC for an evaluation/assessment without a doctor’s referral. For reimbursement, some insurance plans require a medical doctor’s prescription. Not all insurance plans require a medical doctor’s prescription, but some do.

If you have already consulted with your physician, or plan to, they may refer you to a specific physical therapy facility. Regardless of where the physician refers you, it is your legal right to seek treatment from the physical therapist of your choice. You are not bound to receive services only at the specific location of referral.

The Consumer Bill of Rights protects your right to a choice of health care providers that is sufficient to provide you with access to appropriate high-quality health care.

Our Rates

At IPA Physio we not only believe this is the ideal way to deliver the best possible care to you,
our patient, but we know that it can save you both time and money.

Insurance Information and The Out-of-Network Advantage

As an out-of-network provider, IPA Physio OC is able to provide high quality Physical Therapy in the context of one-hour, one-on-one treatment sessions. We are not constrained by contracts or any third-party requirements that would limit the time we spend with clients or the care we provide. This is a unique advantage.

Your reimbursement is dependent on your particular insurance plan’s out-of-network coverage and subject to your deductible. It is in your best interest to understand your insurance and to maximize your insurance reimbursement.

Most of the time, when you see a Physical Therapist (PT), your insurance benefits will not kick in until you have met your deductible. Deductibles are inversely related to premiums – the higher the deductible, the lower the premium (and vice versa). Deductibles are typically in the range of $1,000-$3,000 for an individual and $2,000-$6,000 for a family (though this varies significantly from one insurance plan to the next). If your deductible is $2,000, this means you will be required to pay $2,000 before your insurance contributes anything. After you have spent $2,000 you will be required to pay you co-insurance (usually about 50%) until you meet your out-of-pocket maximum. Once you have met your out-of-pocket maximum, your insurance will cover the entirety of your ‘medically necessary’ costs.

In-network PTs have contracts with particular insurance companies to accept discounted rates. This rate is passed on to you, the consumer. However, to compensate for decreased reimbursement, these in-network facilities typically see more patients for a shorter duration of time. Instead of the one hour of one-on-one care you would receive at IPA Physio OC, you will typically receive 20-30 minutes of care with a licensed PT, followed by time spent with a PT aide doing exercises or utilizing passive modalities such as ice, heat, or electrical stimulation. Until you meet your deductible, this model will not save you much (if any) money. And the quality of care that you receive will not be equal to the care you will receive at IPA Physio OC.

If you happen to have a low deductible, or are in a situation where your deductible has been met (i.e. post-operative), then it will likely cost less per visit to go to an in-network provider. Keep in mind that the time spent with a licensed therapist will also be less. If you compare the price you will pay for three 20-minute treatment sessions at an in-network facility to the price you will pay for one one-hour treatment session at IPA Physio OC, the cost differential will be minimal on a per-minute basis.

At IPA Physio OC we are proud of the quality of care and the value we provide to our clients. Our therapist are highly trained manual Physical Therapists. We hold ourselves to a high standard and expect results that are superior to and quicker than what you will experience in a traditional in-network PT clinic.