An outpatient orthopedic/neurological private practice serving Mendocino County & Ukiah since 1979
Direct Access
Medicare patients can schedule an initial evaluation without a doctor's referral. After an exam, your PT will send a report and recommended treatment plan to your physician. Once approved by your physician, you can schedule up to 12 visits within 45 days. The PT can evaluate and begin treatment while waiting for the Plan of Care to be signed within 30 days of your initial visit..
Privately-insured and private pay patients can schedule an evaluation and up to 12 visits within 45 days without referral, unless, upon exam, your PT recommends that you see your physician before proceeding. (The limits only apply to patients directly seeking physical therapist services without a diagnosis.)
At the end of the treatments, if more visits are needed, your PT will submit a re-evaluation to your physician for approval.
According to treatment data, 90 percent of patients will not require services beyond 45 days/12 visits.
If you require additional services beyond the 45 days or 12 visits, whichever comes first, you will need to be referred to your physician for an exam and signed Plan of Care (POC). If you don’t have a physician, your PT may refer you to a physician . And, if you have a diagnosis from a physician prior to the 45-day/12-visit deadline, you would be allowed visits beyond the time limits.
A good rule of thumb: check your plan's coverage with your benefits' representative before scheduling.
Insurance..what you need to know
Physical Therapy coverage can be confusing since individual insurance plans vary widely and change frequently. If you have questions about Insurance and/or Billing or are non-insured, keep scrolling.
California law allows Direct Access to Physical Therapy services. Requirements vary between private insurers & Medicare
You are responsible for knowing the details of your coverage which determines the extent of your financial responsibility since individual insurance plans vary widely and change frequently. If you have questions concerning your coverage, please contact your carrier directly. Your plan's Customer Service number is on the back of your benefit card.
Provide a copy of your benefit card and update any changes in your coverage with our office manager.
If we are not an in-network provider for your insurance company, be aware that most have out-of-network benefits.
The plan's Customer Service representative can provide this information. Please inquire before scheduling your appointment.
Check your plan to know your provider's covered vs. non-covered benefits.
Non-covered benefits include treatment deemed Not Medically Necessary by your insurance company,
even when such treatment is recommended by your physician. You will be financially responsible for the charges.
Be aware of the plan's benefit limitations, your deductibles, co-insurance and co-payments.
Please pay any patient responsibility indicated by your insurer. This will be on your EOB (Explanation of Benefits) that your insurer will mail to you.
If your plans are not paid, contact your insurer. Our office manager will be happy to assist you in the event a response is not forthcoming from your plan's representative.
We will file insurance claims as a courtesy and extend a sixty-day grace period to you, after which you may be held responsible for the entire balance.
Patients without PT insurance coverage can schedule treatment by calling the office. (Refer to DIRECT ACCESS above.)
Patients who pay at time of treatment receive a discount. For the discount amount, call 707.462.9784.
The Cost of Treatment: We base our charges for Physical Therapy treatment, as is customary, on the amount and type of services you receive. Therefore, we cannot tell you in advance how much your your treatment will cost. However, when your coverage is verified, we can provide you with your approximate cost.
Liens: We accept liens on a case-by-case basis. All liens must be approved before the start of treatment.
Voluntary Termination of Care (TOC): It is the policy of Mendocino Physical Therapy that, should you choose to terminate your care and treatment, any outstanding fees for professional services rendered to you will be immediately due and payable.