Accepted Insurances

Reform Physical Therapy works with most major companies to ensure our patients can focus on their physical health rather than worry about how they are going to pay for treatment.

PLEASE NOTE:

In an effort to minimize confusion or delay in treatment, our Reform Team will:

Verify your insurance benefits! We will tell you if you have a co-pay, deductible, or co-insurance.
Submit authorizations if needed! If your insurance requires an authorization, our team will take the necessary steps to ensure your visits are covered.
Help you acquire a referral if one is necessary! Though Maine is an open-access state, your insurance carrier can still require a referral in order for services to be covered.
If, by some chance, your insurance carrier denies your claims, our team will take the necessary steps to resolve the issue and re-submit corrected claims.

Most of the insurance policies we accept are listed below, but if you do not see yours listed, please contact us.

AARP United Healthcare
Aetna
Anthem & Anthem Federal Plans
Banker’s Life and Casualty
Beacon Health
Champ VA
Cigna
GEHA
Harvard Pilgrim
Health Plans
HealthNet
Humana
Maine Community Health Options
MaineCare – Adult & Pediatric
MaineSense

Martin’s Point – USFHP & Generation’s Advantage
Medicare
Meritain Health
MultiPlan
Mutual of Omaha
Patient’s Advocate
Samba
Taro Health
Today’s Options
Togus & VA
TriCare
Ultra Benefits
UMR
United Health Care
Wellcare

Additional Payment Methods:

For patients who do not have insurance coverage, cash, check or credit card payments are accepted.

We accept MasterCard, Visa, and Discover.

Involved in an accident or injured at work?

We also treat patients who are injured as the result of an auto accident or work-related injury. These companies are billed directly for the convenience of our patients. Our team will need your:

Accident Information: date, state of occurrence, at fault vs. not at fault
Insurance Information: insurance carrier, adjuster’s contact information, claim number
Other Information: if a lawyer is involved, please provide us with accurate contact information

Insurance FAQs:

In short, your deductible is the amount you pay BEFORE insurance kicks in. For example, if you have a $1000 deductible, you will have to pay $1000 of your covered healthcare costs before your insurance kicks in.

You can have an individual deductible that applies only to you, but some people with family plans have a family deductible that includes all covered family members. Typically, if the family deductible is met it means your individual deductible is no longer part of the equation. This can vary from plan to plan though, so always confirm with your insurance provider if you are unclear.

Your co-insurance is the percentage you pay after you have met your deductible. For example, say you have a $1000 deductible, a $4000 out-of-pocket, and a co-insurance of 20%.

You would pay 100% of the first $1000 spent on healthcare costs.
Once you have met your $1000 deductible, you would pay 20% of billed services, while your insurance would pay the remaining 80%.
You would continue paying 20% of the costs *until* you had paid a total of $4000 and meet your out-of-pocket. Once your OOP has been met, your insurance would then cover 100% of the billed services.

A copay, or copayment, is a flat rate you pay for a given service. These flat rates are decided by your insurance provider and should be listed in your summary of benefits, which is typically given to you by your insurance provider at the start of your plan term. Copays are to be paid at the time of service.

An authorization is a decision made by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary.

Not sure if you need an authorization? Your summary of benefits should tell you which services require an authorization, but we can also tell you. If you provide us with the necessary information, we will contact your insurance provider to determine the benefits specific to your plan.

A maximum out-of-pocket, or OOP, is a cap or limit on the maximum amount you can spend on covered healthcare services during your plan period. Emphasis on the word *covered*. If a service is not covered by your plan, it will likely not apply toward your deductible or OOP. Once your OOP has been met, you should be responsible to pay 0% of covered services.

Most medical services are billed using CPT codes. These codes have a defined meaning and time limit that varies based on the service. Your physical therapist will bill the appropriate codes to reflect the time spent with you and services provided. The time that they spend monitoring your exercises is billed separately from the time they provide manual therapy, etc. The services are billed in units which equate to the number of minutes spent providing each service, which is why the price can vary. Not only are Initial Evaluation visits longer than standard, but they are more in depth and use different codes, which is why they tend to have a higher cost than standard visits.

Contracted rates vary by insurance provider. Reform Physical Therapy does not set the price for the CPT codes used.

Your summary of benefits should outline your coverage for physical therapy. If you are not completely sure, you have a couple of options:

You can call your insurance provider and ask them to explain your benefits to you. They will be able to tell you if Reform is an in-network provider, the details of your copay, co-insurance, deductible, and OOP, as well as any other information you may want to know.
You can provide us with the necessary information (full name, DOB, member ID number, etc.) and we can contact your insurance provider for you to inquire about your benefits.