We invite you to discuss with us any questions regarding our services. The best health services are based on a friendly, mutual understanding between provider and patient. OUR OFFICE FILES YOUR CLAIMS TO YOUR INSURANCE CARRIER(S) AS A COURTESY TO YOU.YOU ARE RESPONSIBLE FOR FOLLOW-UP COMMUNICATION WITH YOUR INSURANCE COMPANY SHOULD THERE BE A PROBLEM IN PROCESSING A CLAIM.
Our policy requires payment in full for all services rendered at the time of visit. We accept cash, checks, and credit cards as payment. If your account is not paid within 90 days of the date of service and no financial arrangements have been made, you will be responsible for legal fees, collection agency fees, and any other expenses incurred in collecting your account.
To give you the best possible service, we believe your time and our time is very valuable for treatment. WE HAVE A STRICT LATE CANCELLATION, RESCHEDULE OR NO SHOW FEE OF $75. IN ORDER TO NOT BE CHARGED, WE REQUIRE A 24-HOUR NOTICE. YOUR CARD WILL BE AUTOMATICALLY CHARGED.
I authorize the staff to perform any necessary services needed during diagnosis and treatment. I also authorize the provider and or managed care organization, to release any information required to process insurance claims.
Credit Card Holder Information
Credit Card Authorization
Please note our office files your claims to your insurance carrier(s) as a courtesy to you. Your insurance coverage is a contract between you and your insurance carrier, thus your entire account balance, including those charges filed to your insurance company, remains your RESPONSIBILITY. Your credit card will be charged for insurance co-payments at the time of service, for any balance owed after review of your final insurance payments, and for any late cancellation, reschedule or no show fees. THE AUTOMATIC CHARGE FOR EACH LATE CANCELLATION, RESCHEDULE OR NO SHOW IS $75. Any credit remaining on your account after all insurance payments have been made will be refunded to you. I further understand that this form will be attached to my permanent records and can be used for all future treatment. It will not be divulged to any person not engaged in the maintenance of said files.
Important Things to Remember
YOUR INDIVIDUALIZED TREATMENT PLAN
Our physical therapists will prescribe a treatment plan with a specific frequency and duration. You schedule according to their recommendation and you’ll be on your way to healing with the best!
Ask questions regarding insurance, your financial obligations or your treatment plan. We are open to discussion so please call or email immediately so we can help resolve any issues.
MULTIPLE TREATMENT AREAS
We separate out cases by body part or diagnosis, especially if there are multiple complaints. Some insurance plans also limit the amount of body parts we can treat per case. This provides the best care for your condition. If you want a different body part treated, it may require a full evaluation and confirmation of insurance coverage.
24 HOUR RESCHEDULE/CANCEL/NO SHOW POLICY
Give us 24 business hours notice at minimum to change any appointment. If not, it is an automatic $75 fee to you, not your insurance.
WE RUN ON TIME
You will receive an appointment confirmation via email two days prior to each appointment. This is your reminder. Please arrive on time. If you are late, you will miss out on the 1-1 time with your therapist.
CHANGE OF CLOTHES
Please bring a change of clothes depending on your treatment area. You can leave your clothes here so that you do not need to dress for your appointment.
WORKERS COMPENSATION & NO-FAULT INSURANCE/IME’S
You must routinely see your doctor and receive an IME (Independent Medical Examination) to be authorized for further visits. If you miss your IME, you may be financially responsible for any unauthorized visits. Workers’ Compensation Patients: You must see your doctor to get a MG-2 form before your 28th visit to continue your care.
If you receive any checks from your insurance company, please bring them into our office. They are payment for our services. You are legally responsible for turning them over to your service provider. **Required for certain insurances only.
Thank you for following our policy practices to give you the Best PT in NJ!