Insurance & Pricing

Every individual’s insurance plan is unique and the specifications regarding copays, deductibles, and prescription requirements will differ from person to person. We strongly encourage all patients contact their provider to verify coverage prior to booking.

Stay Ready Physical Therapy & Fitness is a preferred provider with most PPO insurances. Accepted in-network PPOs include Blue Cross, Blue Shield, and Medicare, and accepted out-of-network PPOs include United Healthcare and Aetna.

*All patients are required to pay their copay, deductible, or out-of-pocket fee at the time of their appointment.*

Understanding Insurance Lingo

What is a deductible?: Deductibles refer to a fixed dollar amount insurance subscribers must pay out-of-pocket on healthcare services and treatment prior to their insurance kicking in to cover remaining eligible expenses. Most commonly, once a deductible is met, patient responsibility (copays/coinsurance) begins.

What is a copay?: A copay is a flat-fee dollar amount insurance subscribers must pay for medical services. They are usually a small fraction of the deductible and can vary depending on the service, treatment, or medication type.

Example: Let’s say you have a deductible of $2,000, a copay of $25, and a doctor’s appointment that costs $100. If you have yet to meet your deductible, you will need to pay the $100 rate when you see the doctor. If you have already met your deductible, meaning you have already paid $2,000 or more in insurance covered services, you will only owe the copay rate of $25.

What is coinsurance?: Coinsurance is a percentage of a covered health care service that must be paid after an insurance subscriber meets their deductible.

What is an out-of-pocket rate?: Out-of-pocket rates refer to the amount you pay directly for a service or expense, without seeking reimbursement from insurance or another source. This include expenses like deductibles, copays, coinsurance, and self-pay rates.

Do I need a prescription from my provider to make an appointment?: The short answer is it depends. In 2014, Direct Access legislation was passed allowing patients to seek treatment without a doctor’s prescription for up to 45 days or 12 visits, whichever comes first. After that, it would be required to see a medical doctor for your diagnosis and obtain a prescription for continued physical therapy. However, this does not bypass the requirements set by your healthcare plan. If you would like to bill with your insurance, it is plan-dependent if you need a prescription. We strongly encourage all patients contact their provider to verify coverage prior to booking.