Philosophy & Resources > Insurance & Privacy
General Insurance Coverage Information
HMO: For patients with HMO coverage. All HMO policies have a set coverage limit (ie. 20 visits or 2 months). You should determine the amount of coverage available along with your copay amount by contacting your insurance company. It is important to let us know if you have had any previous physical therapy treatment at any other clinic in your contract year as that may shorten your benefit. Copays are due at the time of treatment. If your plan requires a referral you are responsible for making sure it is in place at the time of treatment. Charges for treatment beyond the limits of your policy will be your responsibility.
Medicare: For patients with Medicare. We participate with Medicare Part B. Payments will come directly to us. If you have a secondary insurance, we will bill them on your behalf and then bill you for any unpaid balances. Medicare will not pay for our services if you are under any type of home health care. Medicare has instituted a “cap” on the amount of therapy they will pay for. The cap for 2012 is $1880. Medicare also has a decductible that has to be be met before it will begin covering 80% of allowed charges.
No-Fault: For patients claiming coverage under no-fault insurance. We will, as a courtesy, bill your no-fault carrier. However, if they do not pay, you will be remain liable for our charges. If you have a secondary insurance on which you wish to rely, we must be given that information, especially if it is an HMO, at the time of your first visit, so we may determine if all required treatment approvals are in place.
Workman’s Compensation: For patients claiming coverage through worker’s compensation insurance. You are responsible for providing all necessary information such as carrier, date of injury, case number, etc. We will bill worker’s compensation as required by law however, occasionally, cases are sometimes decided by a worker’s compensation judge to not fall under worker’s compensation. In this event, you would become liable for our charges. If you have a secondary insurance on which you wish to rely, we must be given that information, especially if it is an HMO, at the time of your first visit, so we may determine if all required treatment approvals are in place.
Major Medical: For patients with major medical insurance. Copays are due at the time of treatment. We will, as a courtesy, bill your major medical carrier for the balance and will wait up to sixty days for payment. At that time, any open balances must be paid by the patient.
If you have questions regarding insurance coverage or your account, please call our office at (716) 662-2922 and speak with Gina Cunningham.
We will bill all insurances on the patient’s behalf but we are participating providers for the following insurances. This means we have contracted with these companies to bill a specified rate for our services. However, you will still be responsible for paying any copays/co-insurance required by your policy, for deductibles, for charges not covered due to treatment exceeding your policy limits and for any durable items not covered by your policy.
- Blue Cross
- Community Blue
- Empire – Managed Physical Network
- Independent Health
- No Fault
- North American
- Worker’s Compensation
If your carrier does not appear on this list, they may still cover treatment at our facility but you must contact your carrier to determine the amount they will pay. You will be responsible for the difference between our standard charges and your carrier’s payment. We are not providers for Medicaid.
Orchard Park Location
4 Centre Dr., Suite G,
Orchard Park, NY 14127
Phone (716) 662-2922
Fax (716) 662-3828
Buffalo (City) Location
531 Virginia Street
Buffalo, NY 14202
Phone (716) 332-4838
© 2021 SportsFocus Physical Therapy