Explanation of Billing
Billing Rates:
At Safe Haven Home Modifications Consulting PLLC, we bill each therapy treatment CPT code at $60 per unit, and each evaluation code is billed at $200. These charges have been carefully determined to align with industry standards and ensure affordable and competitive pricing for our clients. Our billing rates are within the recommendations provided by Fair Health Consumer, a reputable resource for healthcare cost information (https://www.fairhealthconsumer.org).
Additional Services and Charges:
In addition to therapy treatments and evaluations, we provide services that are not covered by insurance. These include:
Home Modification Consulting (Preventative): $300
This includes a thorough assessment of the home and full report with a comprehensive list of recommendations prioritized by safety ratings.
Client/Caregiver Training : $100
This includes a revisit to train clients and/or caregivers in safe practices following install of recommended home modifications.
Insurance and Medicare Billing Requirements:
Safe Haven Home Modifications Consulting PLLC is a credentialed Medicare B provider. We will submit the claims for skilled PT services to Medicare B on your behalf and they will send payment directly to us. If you have a secondary insurance after Medicare, they will be billed as applicable for remaining costs. You agree that if your secondary health plan does not honor the assignment and sends payment to you, you will promptly forward the payments to us. You further agree that if your health plan denies out-of-network payment of our claims, in whole or in part, you are responsible for paying any and all unpaid amounts within thirty (30) days of receiving our statement regardless of whether you have filed or plan to file an appeal.
Out-Of-Network:
If your primary insurance is not Medicare B, you may pay upfront for physical therapy services and we will supply you with a “superbill” to submit to your insurance. If your insurance allows out-of-network payments, you will receive partial or full reimbursement directly from them. If your insurance company forwards payment to Safe Haven Home Modifications Consulting PLLC, you will promptly receive such payment in return.
Private Pay:
Private Pay Services are available for clients without insurance or for those who choose not to bill insurance, except for services covered by Medicare. We are required to bill Medicare B for services that are skilled and medically necessary. Private Pay Services are available to Medicare beneficiaries if the service provided is no longer skilled and medically necessary.
We offer a discounted private payment rate for skilled physical therapy services when clients pay on the day of service. This prompt payment discount is offered to clients who do not have insurance or who choose not to use their health plan benefits (except for Medicare B beneficiaries as noted above).
If you choose to participate in our private pay policy, you understand that we will not submit a claim to your health plan and you agree that you will not submit our claims or statements to your health plan in an attempt to get reimbursed for our services.
The prompt pay discount is 50%.
Receipt of Billing Statements:
You will receive a bill if there is a balance remaining after Medicare B and any out-of-network secondary plan have paid for the covered services. Billing statements are generated once insurance has processed the claims and determined the patient’s responsibility.
Understanding Billing Amounts:
Please be aware that the prices listed on the billing statements are the amounts billed to Medicare B. However, the actual amount you are required to pay out-of-pocket may vary. Providers are often reimbursed at rates lower than the charges. Medicare clients have reimbursement rates determined by the federal government.
Understanding Your Insurance Coverage:
It is essential to familiarize yourself with the coverage, co-insurance and co-pay requirements of your specific insurance plan. We cannot predict which services will be covered by individual health plans for which we are out-of-network. Some plans may limit payments to “usual, customary, and reasonable payment.” For Medicare beneficiaries, you can find information on Medicare benefits at your local Social Security office or online at https://www.medicare.gov/.
Coinsurance/Deductible:
If you have a coinsurance or deductible which has not been met, we estimate the co-insurance/deductible amounts based on the insurance information provided at the time of insurance verification. This is an estimate in the setting of any pending charges from other medical providers. As a result, you may have a refund or a balance due.
Refunds:
If an overpayment has been made, a refund will be issued promptly. If you feel a refund is due: please contact us at 207-752-3234.
Insufficient funds:
If a payment is made by check with insufficient funds, the client will be charged a returned check fee of $30.
Past Due Accounts/Collections Actions:
Payment is expected at the time of invoice. Please notify us at 207-752-3234 if you feel you need to set up a payment plan.