Patients and medical providers alike may be wondering just how to go about paying for Dr. Welch’s highly specialized PT services under the partial insurance/ cash-based model. Welch PT does accept some major insurance companies including Medicare, and some Medicare advantage plans ( PPO only). However, some private insurance, government insurance plans are not in- network, such as Fidelis and Medicaid. The reason some payers are not accepted is due to the extremely low reimbursement rates of those insurance plans. Many PT clinics work around this lower coverage by seeing upwards of 6 patients per hour. Dr. Welch sees all of her patients one on one, therefore, being in network with all insurance payers cannot be feasibly accepted while still providing the exemplary care all patients deserve.
Patients with Medicare as a primary insurance will be processed accordingly, consistent with Center for Medicare Services (CMS) guidelines. Patients must be able to provide their CURRENT medical insurance card prior to the first scheduled appointment, allowing benefits to be verified. When applicable, copays are due on the day of service. No referrals are needed for any patient. Dr. Welch is happy to call your medical provider for you to obtain a referral to streamline the process, when need be, or at your request.
Welch PT is happy to discuss your specific insurance plan and cost of care with you. We understand each patient is individual, and we will do our utmost to communicate your cost of care in advance of services rendered. We HATE surprise medical bills- so we do our best to be 100% transparent about this.
Patients with insurance plans out of network at Welch PT-
Option 1- Cash based model for services- Payment is due at the time of service. Patients may have experienced this model when treated by a dentist or chiropractor. After services are rendered, patients will be provided with documentation and a receipt to “self-submit” directly for reimbursement from their insurance company. In this model, there is no copay for the appointment. In traditional private insurance models, most patients have an average of a $50 copay for each appointment.
Out of pocket costs-
Initial evaluations= $175
Follow up sessions=$90
Keeping that in mind, here is an example of how a payment may break down.
“Mrs. Stiffknee” (our example patient) has Excellus BCBS private insurance through her employer and makes an appointment with Dr. Welch for an initial evaluation for her knee pain. She need not have a referral.
She has a one-on-one private evaluation costing $175, which she pays with credit card, and receives documentation to self-submit. Her insurance then pays Mrs. Stiffknee with a check, mailed to her home for $100 fifteen days after she sends in the paperwork.
Benefits of “cash based” model and Welch Physical Therapy’s “teach you how to help yourself in the least amount of time/ treatment sessions” principle
- Your Physical Therapist is being paid for the services she is providing to YOU; without the insurance company receiving a large cut of your money- keeping your business truly local.
- Under standard PT models- patient is seen 3 x per week with copays= $150 per week over a period of 6 weeks (Average total cost to patient=$900)
- Dr. Welch will likely need to see you one time per week, as all sessions are one-on-one, and longer in treatment length. She will likely be working with you 45-60 minutes per session. (Average total cost to patient, after self-submitting and re-imbursement= $360)
Option 2- Patient may choose not to self-submit to insurance or does not have health insurance and would be responsible for the entirety of the fee for services.
Dr. Welch will work with you, and your financial situation to guide you to the treatment duration and frequency you require for your specific condition. We are confident you will be satisfied with your results without breaking the bank and look forward to your business.
Welch Physical Therapy 