I scheduled as a new patient but chose not to move forward after reviewing the paperwork and asking questions about a billing policy that I believe patients should be aware of before starting care.
Their new patient paperwork states that a $100 "Administrative Fee" is due at the time of evaluation, is not billed to insurance, and is charged "per case." I was told over the phone that different referral areas, such as cervical spine and lumbar spine, could be treated as separate cases. When I called for clarification, the office confirmed that this fee is for internal administrative tasks such as maintaining the patient profile, correspondence with doctors, referrals, and related office communications. They also confirmed it is charged in addition to insurance copays/coinsurance and is not billed to insurance because they consider it "non-medical."
Patients using Tricare, Medicare, Medicare Advantage, or any in-network insurance plan should be very careful before paying this type of fee. For covered medical care, your patient responsibility should generally be determined by your insurance plan/EOB - such as copay, deductible, or coinsurance - not by a separate office-created "administrative," "access," or "per case" fee. Tricare/TriWest specifically told me that both the facility and PT were in-network for my plan and that contracted providers may not charge beneficiaries separate administrative, concierge, or access fees for medical services. The Tricare/TriWest Provider Handbook states: "Providers may not charge TRICARE beneficiaries administrative fees."
This is especially concerning for elderly, disabled, Medicare, Medicare Advantage, and military-family patients who may assume that if a front desk asks for payment, they are legally required to pay it. Before paying any separate fee like this, I strongly recommend calling your insurance plan and asking: Is this provider in-network for my exact plan? Are they allowed to collect a separate administrative/access fee in addition to my copay, deductible, or coinsurance? Should I pay anything that is not shown as my responsibility on an EOB?
I cannot speak to the quality of the physical therapy itself because I canceled before being seen. But I did not feel comfortable receiving care from a practice that required this type of fee and did not respond to my written questions asking what non-covered service the fee was for. read more