Click here to download and print all the forms you'll need for your first visit. The download includes the following:

A welcome letter

Consent for purposes of Treatment, Payment & Healthcare Operations Form:
It is essential that you take responsibility for the care you are participating in. We will make every effort to work with your insurance, but ultimately you are responsible for the care you receive. If you are dissatisfied for any reason, we welcome your feedback, as it is our mission to provide uncompromised customer service - and we can only do this through allowing ourselves the opportunity for feedback, change, and growth.

Patient Information Sheet
This allows us to contact your insurance company and verify and identify your level of coverage! This helps us to work with you so that you can receive your healthcare within your budget without additional financial concerns.

Patient Intake Questionnaire
Tthis allows you to provide your therapist with information regarding your medical history and specific history of your current complaints. Your accurate information on these forms will assist your therapist in an extensive assessment of how your pain or immobility is affecting your everyday functioning.

Notice of Privacy Practices
This spells out our policies.

Healing Bridge Physical Therapy is a provider for most insurances available to Central Oregon employees. These include but are not limited to:

•	Pacific Source OEA	•	Cigna Great West
•	Healthnet	•	Champus Providence EPO
•	Jeld-Wen Oregon Health Plan	•	Lifewise ODS
•	St. Charles Medical Center United Health Care	•	Blue Cross/Blue Shield PPO (we are a preferred provider)
•	Regence Blue Cross/Blue Shield-Traditional plans	•	Clear Choice (click to go to directly)
		•	Medicare (click to go to directly)

If you do not see your insurance provider listed here, that does not necessarily mean that you cannot access our services. Please call our office and we will be happy to contact your insurance for you to determine coverage, including deductibles and co-pays.

Ultimately, it is your responsibility to know your insurance plan and coverage. However, we pride our business on exceptional customer service and will work with you to make sure that your portion of the physical therapy expense fits your budget and expectations. If you begin therapy and have not discussed coverage with one of our accounts representatives, please do so as soon as possible.

Also, if we are not a provider for your insurance, that does not necessarily mean that we will not get reimbursement from your insurance company. Again, it is important to have our Patient Account Specialist contact your insurance so that we can work out a payment plan for you.

We encourage our patients to be educated and proactive regarding their healthcare. You may want to contact your insurance company for your own benefits information. If your information is different from ours, we can make another phone call for clarification.

Your bill will vary depending on the treatment you receive and the billing codes used. We have recently completed a cost comparison with the other physical therapy clinics in Central Oregon, and our rates are typically much less than other clinics. On average, a one hour treatment of one-on-one time with your therapist will cost between $140.00 - $170.00 in charges to your insurance. (This compares to $200 or more at other regional clinics.) Return to Top of Page

Questions to ask your insurance company:
(Click here for a form you can print out)

•	Does my plan cover Outpatient Physical Therapy?
•	What is my deductible?
•	Has my deductible been met? If not, how much of the deductible has been met?
•	What is the amount of copay I will need to pay?
•	Are there any visit limits or restrictions?
•	Are my visit limits based on calendar year, benefit year, or other time frame?
•	Do I need to obtain prior authorization for physical therapy?
•	Do I need a referral from my physician?

Write-Offs: For many insurances, certain codes have a maximum limit, and any charges over that amount are an automatic non-billable write off.

Co-pays and Coinsurance: Co-pays vary depending on insurance plans. We will determine your co-pay during your first visit or as soon as we can contact your insurance company. Because co-pays are often a percentage of the allowable charge to your insurance company, it is not always possible to accurately predict the exact amount owed per treatment. However, we encourage that you make some payment towards each treatment to avoid a large bill at the end of your physical therapy. Return to Top of Page

Deductibles: This is the amount of out-of-pocket expense required by the insured before your insurance will begin paying towards your medical expenses. It usually combines all medical expenses, your including doctor visits. Each insurance policy varies on the amount of deductible that is required. Because it is difficult to get full accuracy on the amount remaining on your deductible, we will wait until we hear from your insurance company to charge you this amount.

Statements: We will send out monthly statements. Unfortunately these can be confusing because of claims that are still pending collection from your insurance company. Do not be alarmed if the total amount of money due reflects a significant amount. As your insurance payments come in we can give you more accurate information on the amount actually owed by you. Please contact our accounts representatives for any questions and concerns.

Cash-Pay: For patients who choose not to use, or do not have insurance coverage for physical therapy, we are able to offer our services at a significant reduction. These cash-pay services cannot be billed to your insurance. We do not attach CPT codes, otherwise, we would have to charge the same amount. We provide this discounted price to make your healthcare accessible and affordable, and also because the overhead expense of billing and seeking reimbursement from insurance companies is extraordinarily high. Cash-Pay Physical Therapy: $95.00

Rest assured that you will receive the same great care whether you are paying on a cash basis or we are billing your insurance. Return to Top of Page

Medicare
MEDICARE: We accept insurance for all Medicare recipients. We will provide billing to both Medicare and your secondary or supplemental insurance, if you have one. If you do not have a secondary or supplemental insurance you will have a 20% co-pay on the allowable amount accepted by Medicare. This co-pay amount usually averages $10.00 to $18.00 per visit. There is also an annual deductible for Medicare of $100.00.

Medicare has strict regulations to qualify you for coverage. You must have a physician's referral, and return to see your physician every 30 days in order to continue physical therapy. In addition, your therapist will track your progress, as we must be able to document clear functional progress to justify continued services.

Clear Choice
Healing Bridge Physical Therapy is a provider for all Clear Choice Plans. If you are on the Clear Choice Medicare Plan and receive your prescription for physical therapy services from your physician, you can have an initial evaluation and 8 follow up visits, before having to receive additional authorization. We may then request an additional visits from Clear Choice once we submit our progress report. Return to Top of Page

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