Payment Options and Insurance Information
Payment options at the Gentle Pain Release Center include most insurances, Visa, MasterCard, Medicare, cash, check, and CareCredit®
, an extended payment plan that patients can sign up for online, by phone, or in the office.
Insurance: What the Patient Needs to Know
Treatments at the Gentle Pain Release Center® are covered by Medicare, Blue Cross/Blue Shield, Crescent PPO, and other standard carriers. At this time, Medicaid does not cover our work.
Your insurance will be billed by the Gentle Pain Release Center® as a service to you. Since insurance can be confusing, the following definitions, information, and instructions may be helpful.
Definitions
Charge – the amount billed to the insurance company.
Allowable – the amount that the insurance company actually pays, which is typically less than the charge.
Accept assignment – we accept the amount that the insurance actually allows, but you are still responsible for the “co-pay” amount, which is usually a fixed dollar amount or a percentage of the allowable (typically 80 percent).
Deductible – the amount that you must pay at the beginning of the insurance coverage’s fiscal year before the insurance company begins to pay.
How much will I pay out of pocket?
It is difficult for us to tell patients upfront what their out-of-pocket costs – typically a 20 percent co-pay – will actually be.
Medicare sets precedents for many insurance companies. Medicare studies the charges in a region of the country and then establishes its “allowable” based on about 65 percent of the average charges in that region. One can then see why charges need to be much higher than the actual allowed amount. For example, if a charge is $100, Medicare would typically reimburse about $65. We will provide you with examples of charges and allowables for Medicare upon request.
Other insurance carriers vary in their allowables, which are often not disclosed to you or us until the bill is actually sent and payment received.
Do I need a referral to receive your services?
Insurance companies almost always require referrals. If your insurance provider is not Medicare, you must call the 800 number on your insurance card and get the following information:
- Is a doctor’s referral or “Letter of Medical Necessity” required in order to receive physical therapy? A referral is often necessary, and you may need to see your regular physician before receiving physical therapy. If you have recently seen your physician about the problem for which you are seeking physical therapy, you may only need to call his or her office to request the physical therapy referral. If you need a Gentle Pain Release Center referral form to take to your regular physician, download either the Asheville office form (pdf) or the Morganton office form (pdf).
- What is your deductible, and how much of that deductible has been met?
- What is your co-pay in a dollar amount per visit or a percentage of the allowable?
- Is there a limit on the number of physical therapy visits per year? If so, how many have you had to date this year?
We highly recommend that when you call your insurance company, be sure to write down the date, the time, and the name of the person to whom you spoke. Please bring this information with you to your first physical therapy visit.
If your insurance provider is Medicare, you will need a referral from your physician but you do not need to call Medicare before receiving physical therapy services.
Still have questions?
Insurance co-pays can be very confusing. If you have questions, we will be glad to try to answer your questions. Billing questions should be directed to Mariya Severenchuk, Billing Coordinator. (828)665-1173.
![[view a printable PDF referral form for our Morganton Office in a new window]](images/buttons/referral_form_morganton.gif){kind=small}
