Insurance & Billing
We at Carlson Procare appreciate that the cost of medical services can be difficult to understand. One of our goals is to make the billing process as easy and transparent as possible.
We accept all major insurances, including but not limited to:
● Aetna Healthcare
● Auto Insurance
● Blue Cross Blue Shield (including Anthem and BCBS Federal)
● Cigna
● Connecticare
● Medicare
● Tricare
● United Healthcare (including Oxford)
● Veterans Affairs (VA) Community Care
● Workers Compensation
Please see below for additional information and resources regarding the billing process.
If you have further questions, please call our billing department at 860-799-6320, option #1.
For payments, please use our bill pay option shown on this page. You can also call our office at the number above.
Approximate Costs
Once you’ve made an appointment, the Carlson Procare verification team will check your benefits with your payer. This will include obtaining information about any patient responsibility – copays, deductibles, coinsurance, out of pocket maximums, etc. At your visits, we will collect your copay or an estimated deductible/coins based on average processing we’ve seen on other claims associated with your carrier.
Here’s a breakdown of what those costs may be. Remember – these are estimates based on averages. The actual amount processed by your insurance may be higher or lower:
- Appointments: average of $70 to $90 for plans with unmet deductibles
- Co-pays: $10 to $75 per visit depending on your plan
- Coinsurance: average of $5 to $30 per visit depending on the percentage
Self-Pay for patients with no coverage or have maxed out their benefits:
● Initial Evaluation – $150
● Follow-Up Appointments – $90
Payer |
Deductible (varies by treatment) |
| Aetna | $80 – $150 per visit |
| Anthem/BCBS | $75 – $150 per visit |
| Cigna | $55 – $150 per visit |
| Connecticare | $77 – $89 per visit |
| Medicare | $70 – $150 per visit |
| Tricare | $75 – $130 per visit |
| UnitedHealthcare | $70 – flat rate |
Higher end of ranges is usually for evaluations or re-evaluations
Once you’ve been seen, our Billing Team will submit your claims on your behalf to your insurance carrier. Processing usually takes 1-2 weeks. We highly recommend you sign up for access to your insurance company’s online portal, so that you can check your benefits, monitor your deductible and out of pocket (OOP) limits and see how your claims have been processed.
Our Billing Team is always happy to help with any questions you may have regarding the claims process.
No Show and Late Cancellation Policy
At Carlson Procare, it is our mission to be committed to your personal health and well-being. In order to do so, it is extremely important that you adhere to the plan of care agreed upon by you and your provider. Through evaluation and adherence to your home exercise program, you begin the process toward recovery. Follow up sessions are a time to readdress impairments and progress you further in your recovery process. Without adequate follow up, full recovery becomes less probable.
We understand that you may need to cancel an appointment occasionally, due to illness, schedule conflicts, weather, etc. Please contact our office no later than 24 hours prior to your scheduled appointment time. You should do so by calling the main number of the clinic you’re attending. If we are unable to take your call, please leave a message giving a brief description of your reason for cancellation, the date and time of your appointment and if you would like to reschedule.
If you do not show up for your appointment, or cancel within 24 hours of your appointment time, it will be considered a no-show with a fee of $50 applied to your account. These fees MUST be paid prior to your next appointment. We will waive the fee for your first late cancellation or no show.
Late cancellations and No-Shows have negative consequences:
● Limit the efficiency of your progress, taking longer to get better!
● Reduce appointment availability for our other patients
● Loss of time and revenue for Carlson Procare
OUR POLICY
● 1st Cancellation or No Show: Warning and Automatic Enrollment in Appointment Reminders (If not already enrolled)
● 2nd Cancellation or No Show and each additional occurrence: $50 Fee
● Following a third No Show, your account and treatment plan will be reviewed by the administrative staff.
Upon violation of this policy, payment must be collected prior to the next visit and before any additional future appointments can be scheduled.
Insurance 101 for PT Patients
What is a deductible?
This is the total amount you must pay out-of-pocket before your insurance starts to pay. For example, if your deductible is $1,000, then your insurance won’t pay anything until you have paid $1,000 for services subject to the deductible (keep in mind that the deductible may not apply to every service you pay for). Furthermore, even after you’ve met your deductible, you may still owe a copay or coinsurance for each visit. In most cases, your deductible goes toward your out of pocket maximum.
What is a copay?
This is a fixed amount that you must pay for a covered service, as defined by your health plan. Copays usually vary for different plans and types of services. Typically, you must pay this amount at the time of service. Again, copayments are fixed—which means you will always pay the same amount, regardless of visit length. In most cases, copayments go toward your out of pocket maximum.
What is a coinsurance?
This type of out-of-pocket payment is calculated as a percentage of the total allowed amount for a particular service. In other words, it’s your share of the total cost.
For example:
· Your insurance plan’s allowed amount for an office visit is $100.
· You’ve already met your deductible.
· You’re responsible for a 20% coinsurance.
In this situation, you’d pay $20 at the point of service. The insurance company would then pay the rest of the allowed amount for that visit. Keep in mind that the coinsurance amount may vary from visit to visit depending on what services you receive.
What is the coinsurance for Medicare Part B?
Medicare Part B patients are responsible for a 20% coinsurance, which typically amounts to $11-25 per visit. If you have original Medicare as your primary insurance, but you also have a secondary insurance, the secondary payer becomes responsible for the 20%. In some cases, the secondary insurance also charges a copay, coinsurance, or deductible. We recommend contacting your secondary insurance carrier to find out.
Medicare has a deductible that must be met every year. For 2025, this is $257. MOST supplemental plans do not cover the deductible. You will be responsible for this amount. Once met, the 20% coinsurance will apply and should be covered. Again, confirm with your carrier.
What if I can’t afford to pay these amounts as frequently as I need care?
Your health is our number-one priority. As such, we are happy to arrange a payment plan that works with your budget. That way, you can pay for your care over a timeframe that works for you. Simply ask to speak to our office/billing manager.
EOB Definitions:
EOB – Explanation of Benefits – document issued by your insurance carrier explaining how your claim(s) processed
- Date of Service (DOS): The date of your visit.
- CPT Code: The code denoting each service provided to you during your visit (e.g., manual therapy, therapeutic exercise, self-care instruction, aquatic therapy, etc.). You can request a list of these codes—along with their explanations—from your insurance company.
Billed Amount: This is the amount we billed the insurance company for that particular service. The billed amount will vary depending on the duration of the service and the types of treatment provided.
- Adjusted Amount: This amount is not a payment, but rather a write-off or “reduction.” It is based on the contract in place between your provider (us) and your insurance company. Neither you nor the insurance company pays this amount. The provider essentially writes it off.
Patient Responsibility: This column may be labeled “Deductible,” “Copay,” “Coinsurance,” or “Patient Pay.” It is the amount that you, the patient, are responsible for paying. If a secondary insurance is on file, we will forward this amount to that insurance for payment. Once we get the secondary EOB back, you will receive a bill for any outstanding balances in the patient responsibility column.
Insurance Paid: This is the amount the insurance company paid us for the services you received on that date of service.
Notes:
● Most insurance companies offer several different plans. Thus, two patients with Blue Cross Blue Shield, for instance, may have completely different benefits, and therefore, completely different financial responsibilities. Some plans have no copays or deductibles; others may have a $10,000 deductible. Furthermore, some providers may not accept all plans from a particular insurance. This is why it is crucial that you investigate the details of your specific plan.
● If your insurance offers an online patient portal, sign up for it! These resources typically enable you to:
● check your benefits
● track your deductible
● see which providers in your area accept your particular plan
● track your claims, and compare claims to your receipts from the doctor’s office (if they don’t match up, you can then follow up on any discrepancies).