Insurance & Billing
As Providers of Physical and Occupational Therapy, we have agreements with most major carriers and networks to provide services to their plan participants. These contracts are for outpatient therapy services. Since plan participation can vary by carrier and/or your employers set guidelines, you should contact your company’s benefits administrator for exact coverage explanations or call the member number on the back of your insurance card.
These are some of the many carriers whose plans are accepted by Carlson ProCare
- Aetna
- Anthem Blue Cross Blue Shield
- Cigna
- Connecticare
- Medicaid/Husky – for patients under 21 (check office for participation)
- Medicare, Medicare Railroad and Medicare Advantage Plans
- Oxford
- PHCS/Multi-Plan
- Tricare East
- UMR
- United Healthcare
- Connecticut Worker’s Compensation
- Auto Insurance MedPay
- Department of Veteran’s Affairs
Please note: not all clinic locations or providers are par with every carrier/contract, so please call for assistance. Our billing office can be reached at (860) 799-6320 for more information. It’s open Monday–Friday from 8:30 am–4:30 pm.
Insurance Terminology
Premium: A monthly payment you make to have health insurance. Like a gym membership, you pay the premium each month even if you don’t use it, or you lose coverage. If you’re fortunate enough to have employer-provided insurance, the company picks up all or part of the premium.
Copay: Your copay is a predetermined rate you pay for health care services at the time of care. For example, you may have a $25 copay every time you see your primary care physician, a $10 copay for each monthly medication and a $250 copay for an emergency room visit.
Deductible: The deductible is how much you pay before your health insurance starts to cover a larger portion of your bills. In general, if you have a $1,000 deductible, you must pay $1,000 for your own care out-of-pocket before your insurer starts covering a higher portion of costs. The deductible resets yearly.
Coinsurance: Coinsurance is a percentage of a medical charge that you pay, with the rest paid by your health insurance plan, after your deductible has been met. For example, if you have a 20% coinsurance, you pay 20% of each medical bill, and your health insurance will cover 80%.
Out-of-pocket maximum: The most you could have to pay in one year, out of pocket, for your health care before your insurance covers 100% of the bill.
Does Insurance Cover My Treatment?
Yes, in most cases it does. Our office will be happy to assist in contacting your insurance company and determining your coverage based on your individual policy. For more information, visit our insurance plan page and please do not hesitate to contact our office. We do offer different payment options for your convenience.
What is the Insurance Process?
Patients are responsible to provide current and accurate insurance information and to let us know if there are any calendar year changes. We will call to verify your benefits and coverage as a courtesy before your first appointment; we will handle any authorization that may need to be done.
How is my Insurance Carrier Billed? Am I Responsible to Pay Anything?
After your first appointment, we will bill your insurance carrier in a timely fashion. Copays are due at the time of your visit. After we receive payment from your insurance company if there is a balance it will be your responsibility and you will be billed. This may be your deductible or your co-insurance.
I Have a Deductible and/or Co-Insurance. Why am I being asked to Pay This at Time of Service?
We are able to determine (in most cases, to the penny!) what we expect your patient portion to be. Most people find it more affordable and more convenient to pay a little at a time, instead of being billed for multiple visits in one bill in a larger sum. We do our best to be accurate, but the explanation of benefit ultimately determines your patient responsibility. Therefore, if you have any remaining balance due as your insurance company processes your claims, you will be billed accordingly, or refunded in the event of an overpayment.
What if Insurance Doesn't Cover My Treatment?
If it is known prior to treatment your insurance will not cover Direct Access, you will be required to obtain a prescription from your physician or pay directly at the time of service. If your insurance denies payment due to lack of prescription, you will be billed accordingly for any sessions denied by your insurance carrier.
What if I Don't Have Insurance?
For patients who do not have insurance, we offer a discounted fee, due at the time of service.
Can I be Billed for my Copays?
Unfortunately, no. A copay is a set amount that is determined between your insurance carrier and your employer. Per your insurance contract, it is required to be paid at the time of service.
We know that copays can be high for some people, but this amount is subtracted from what your insurance company pays us, not in addition to. Please bring your payment at each visit.