Referral

Texas Physical Therapy Association

Referral is no longer needed to evaluate and treat patients.

• Up to 10 business days for PTs with a doctoral degree, or PTs who have 30 hours of CCUs in Differential Diagnosis
• Up to 15 business days for PTs with a doctoral degree who have completed a residency, fellowship training or board certification as recognized by the Texas Board of Physical Therapy Examiners
• Must have at least one year of experience
• Must have liability insurance
• Will still need a referral if treatment is needed beyond the allowed days

A disclosure form must be given to patients who are treated by a physical therapist without a referral. The form shall include language in which the patient acknowledges that physical therapy is not a substitute for a medical diagnosis by a physician, nor is it based on radiological imaging, that a physical therapist cannot diagnose illness or disease, and that such services might not be covered by a patient’s health plan or insurer.

This form is being developed by the Texas Board of PT Examiners and will be required once it is finalized around Nov. 1st, 2019.

Insurance Information

We gladly accept the insurance plans listed below. If your plan is not listed, please call us at (210) 796-3968 as we are always adding new insurance plans.

As a courtesy to our patients, we will verify your health benefits upon your arrival to determine and discuss if there will be a copay, deductible, or coinsurance for therapy services before beginning any therapy.

For those patients who do not have health insurance or those who have maxed out their benefits, we offer a variety of affordable private pay plans.

Disclaimer: While this is an extensive list, health plans do change regularly without prior notification. We recommend that you verify with your health plan what physical therapy benefits you have available.

• Aetna
• Blue Cross Blue Shield (EPO, HMO, POS, ACA exchange and PPO plans only)
• Cigna
• Coventry
• Definity Health
• First Health
• Fiserv Health
• Golden Rule
• Great West
• Humana
• Medicare
• PHCS
• Southcare
• Tricare
• Unicare
• United Healthcare

We have included most of the major plans with which we are in-network. However, this is not an
all inclusive list. Please call the office to verify other insurance plans.

Health Insurance Terms

Below, you will see a list of terms that pertain to insurance coverage and payment for health services.

Co-insurance: in indemnity, the monetary amount to be paid by the patient, usually expressed as a percentage of charges.

• Co-payment: in managed care, the monetary amount to be paid by the patient, usually expressed in terms of dollars.
• Consumer Driven Health Care (CDHC): refers to health plans in which employees have personal health accounts such as a health savings account, medical savings accounts or flexible spending arrangement from which they pay medical expenses directly.
• Deductible: the portion of medical costs to be paid by the patient before insurance benefits begin, usually expressed in dollars.
• Denial: refusal by insurer to reimburse services that have been rendered; can be for various reasons.
• Eligibility: the process of determining whether a patient qualifies for benefits, based on factors such as enrollment date, pre-existing conditions, valid referrals, etc.
• Exclusions: services that are not covered by a plan.
• Flexible Spending Arrangements (FSAs): an account that allows employees to use pretax dollars to pay for qualified medical expenses during the year. FSAs are usually funded through voluntary salary reduction agreements with an employer.
• Gatekeeper: in managed care, it refers to the provider designated as one who directs an individual patient’s care. In practical terms, it is the one who refers patients to specialists and/or sub-specialists for care.
• Health Maintenance Organization (HMO): a form of managed care in which you receive your care from participating providers.
• Health Savings Account (HSA): a savings product that serves as an alternative to traditional health insurance. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.
• Managed Care: a method of providing health care, in which the insurer and/or employer (policyholder) maintain some level of control over costs and utilization by various means. Typically refers to HMOs and PPOs.
• Member: a term used to describe a person who is enrolled in an insurance plan; the term is used most frequently in managed care.
• Open Enrollment: a set time of year when you can enroll in health insurance or change from one plan to another without benefit of a qualifying evening.
• Out-of-pocket: money the patient’s pays toward the cost of health care services.
• Payer: the party who actually makes payment for services under the insurance coverage policy. In the majority of cases, the payer is the same as the insurer. But, as in the case of very large self-insured employers, the payer is a separate entity under contract to handle the administration of the insurance policy.
• Policyholder: purchaser of an insurance policy; in group health insurance, this is usually the employer who purchases policy coverage for its employees.
• Preferred Provider Organization (PPO): a form of managed care in which the member has more flexibility in choosing physicians and other providers. The member can see both participating and non-participating providers. There is a greater out-of-pocket expense if member sees non-participating providers.
• Premium: the cost of an insurance plan shared by employer and employee.
• Provider: one who delivers health care services within the scope of a professional license.