Insured vs. Uninsured Patients - Estimates for Physical Therapy

If you are an uninsured or cash-pay physical therapist, you may be wondering what your responsibilities are when it comes to good faith estimates. Do you have to provide one? What happens if you don’t? In this blog post, we will answer all of your questions and help you understand your rights and responsibilities as a cash-pay physical therapist.

First, let’s start with a definition. A good faith estimate is a document that outlines the estimated cost of services provided by a healthcare provider. This document must be provided to all patients, regardless of their insurance status. The purpose of the good faith estimate is to ensure that patients have accurate information about the cost of services before they receive treatment. It has happened far too many times that a patient undergoes a procedure and wakes up to an outrageous bill from an out-of-network provider that they were not able to verbally authorize.

Now, let’s talk about the specifics of good faith estimates for physical therapy. When it comes to physical therapy, there are a few things that providers must take into account when preparing a good faith estimate. First, they must determine whether the services will be provided in-network or out-of-network. If the services will be provided in-network, then the costs will vary according to the patient’s specific insurance plan and policy. However, if the services will be provided out-of-network, then the physical therapist must provide a good faith estimate of the cost that the patient can expect to pay. This includes any applicable fees for services as well as extra costs, if necessary.

If you’re an uninsured or cash-pay patient, it’s important to have a written agreement outlining all costs that you may be responsible for prior to receiving treatment. This should include the physical therapist’s good faith estimate of what you can expect to pay. By having this information in writing, you can avoid any unexpected surprises later on.

If you have any questions about your physical therapy services, be sure to ask your therapist. They can help explain any costs that may apply to you and answer any other questions you may have about your plan of care.

CMS has created a standardized form for physical therapy practices to utilize when they are seeing an uninsured or cash-pay patient. This form is called the “Good Faith Estimate Disclosure Form for Physical Therapy.” It can be found on the CMS website.

Cash-pay patients are individuals who do not have health insurance and pay for services out of pocket. They may also include people with insurance who have not met their yearly deductible or those who have a high-deductible plan.

The nature of the physical therapy profession typically does not see patients as uninsured or cash-pay prior to them paying for any part of their services. However, in an effort to be transparent and ensure good practice, physical therapists should provide a Good Faith Estimate Disclosure Form for any uninsured or cash-pay patient.

The disclosure form is a document that provides information about the cost of services and what payment methods will be accepted. The form should be given to the patient before any services are rendered, and physical therapists should make a reasonable effort to ensure that patients understand it. Failure to provide a Good Faith Estimate Disclosure Form can result in disciplinary action; although at this time the penalties are not defined.

What is a good faith estimate?

A good faith estimate in physical therapy would be an estimate of the cost of services that will be provided to a patient. This would include the cost of treatment, as well as any applicable fees or other costs associated with the care being provided. This would would include an estimate for the number of sessions, as well as the cost per session. The physical therapist should provide this estimate to the patient before any services are rendered.

Your estimate does not need to be exact. The actual cost needs to be within $400 or less or your estimate at the time the good faith estimate is provided to the patient.

CMS, the APTA, and the private practice section for physical therapists have more resources on this topic, that quickly became a big issue in January.