A variety of options are available to help you finance the cost of therapy:
We recommend checking your spam/junk email folder to ensure that you do not miss any communications from your selected finance company.
Insurance (U.S. Patients)
Our clinics address pain, adhesions and microadhesions that cause pain and dysfunction. We treat the adhesions with the goal of decreasing pain and increasing function.
We provide physical therapy (PT) services. Physical therapists are health care professionals. In the U.S., they are licensed by the state to treat pain and dysfunction.
While you will pay us directly for our services, your insurance company may reimburse you for part or all of your therapy, especially if you have complaints of pain. We will give you copies of all paperwork, including your initial evaluation, daily notes, an itemized billing statement and a letter from our therapists to your insurer stating why they should cover 20 hours of “out of network” physical therapy (more details further down).
Medicare and Medicaid do not cover our level of service.
Our procedure codes are defined and approved by the American Medical Association and include the following common PT codes:
- 97161 – Initial Evaluation (Low Complexity)
- 97162 – Initial Evaluation (Moderate Complexity)
- 97163 – Initial Evaluation (High Complexity)
- 97164 – Re-Evaluation
- 97110 – therapeutic procedure
- 97112 – neuromuscular reeducation
- 97140 – manual therapy
- 97530 – therapeutic activities to increase function
- 97535 – self care instruction
We recommend contacting your insurer and asking about reimbursement prior scheduling therapy. We suggest asking about:
- Your “outpatient physical therapy benefits” — We are considered an “out of network” provider for you. If you are seeking treatment for treatment of pain or adhesions, tell your insurer that you will be receiving “physical therapy treatment for pelvic adhesions” or “physical therapy treatment for pelvic (or other) pain.”
- Whether you need preauthorization — If so, your doctor’s office needs to contact your insurance company for an authorization number, which you will keep for your records.
- Whether you need a physician’s written referral — If so, have your physician write on his/her prescription pad “physical therapy for treatment of pelvic adhesions (or pain).” If you are coming for the accelerated five-day program, it should specify “20 hours of therapy over five days.” S/he should sign, date and give you the note.
Accelerated program clients should tell their insurer that they will be receiving several hours of therapy a day (usually 4 hours a day for 5 days = 20 hours of therapy). Twenty hours of physical therapy per year falls within the parameters of most insurers, but some try to limit you to one hour of therapy a day. Explain that this is a special case, that Clear Passage is one of the few clinics in the country that treats adhesions and/or pelvic pain without the risks of surgery or drugs.
Remind them that therapy is much less expensive than surgery (which can cost $10,000 or more, with anesthesia and hospital surgery room charges). In addition, the U.S. Department of Health & Human Services’ Agency for Healthcare Research and Quality reports that the average cost of a laparoscopy is $44,500, while the cost of lysis (removal) of adhesions is $61,900. In 2010, the average cost of small bowel resection surgery was $114,175; the procedure required 14.2 days of hospitalization (average) and 1 of 15 people died before discharge from the hospital.
Ask to speak with a supervisor, if necessary. We recommend recording the name, time and date of the person with whom you speak.
Complete this form, sign it at the bottom, and send it to your insurer as an inquiry, claim or appeal.