How Direct Billing Works

What do benefits encompass for you at Unique Health by Physiologix?

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The first thing you should know is that benefits are a compensation method for getting paramedical or medical treatments such as massage therapy or physiotherapy. It is solely your responsibility to ensure that your benefits will be accepted and, if not, be able to pay for the service in full. There are many people who have and use benefits, and quite a number, who have but do not use them. If you are unfamiliar with your benefits please continue reading so you know what to expect when trying to use your benefits at our clinic.

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The “Dos” with benefits:

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Check your maximum per session payable, sometimes insurance companies limit you with the amount you can claim or allow a clinic to receive via direct bill on your behalf. This means a session that costs you $70 could very well only be covered for $20 maximum per session and you are required to remit the remaining $50.

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Know your total dollar value available for each service, so if you have $500 to use in a year and they only cover $50 per session, you would need to have 10 sessions at $70 and you will pay $200 ($20/session) out of pocket in order to use all of your insurance.

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Have your benefits card handy that you have received from your employer or insurance provider.

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Know that Unique Health by Physiologix is as helpful as possible and we keep a record of all the dollar values we have direct billed for you, so we will easily be able to tell you how many direct bill dollars you have used with us. This will not encompass any receipts you have submitted yourself, we will not be able to track that.

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Since not all claims are equal, please have photo ID and a credit card ready to put on file encase a claim does not go through BUT was also not rejected; this means that the insurance company has decided to either look into it more, you are new claiming with us, it is after hours of the insurance company, and other possible scenarios. We prefer to do this because over 9 times out of 10 claims will be accepted and paid for in full or just slightly less than the full amount.

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Have another form of payment if a claim is rejected, benefits not active yet, or other issues your insurance company and you will have to sort out.

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The “Don’ts” with benefits:

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Do not expect us to direct bill benefits with no services rendered and share the profits back to you, this is against the rules and regulations of all insurance companies.

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Do not expect us to automatically direct bill, either before or after your service. You must inform us to bill your insurance, without this consent we are not allowed to bill on your behalf. Alternatively you can ask for a note to be put in your account for details regarding how you would like us to bill (ie: bill me, then my spouse’s insurance, and i’ll need a receipt for the remainder to claim under my health spending account).

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If you do not see your insurance provider listed on our website, you are responsible in contacting us prior to scheduling your appointment. Once your appointment is scheduled and you find out that we do not direct bill your insurance provider, you are responsible in paying for the session and a receipt will be emailed to you for your submission.

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***If you have any other questions please do not hesitate to click the Contact Us button on the bottom of your screen and we will answer them as soon as we can***