Physical Therapy for Men, Women, and Children. 803-716-9723
At Pelvic Prime, we believe patients should understand how their insurance works before beginning treatment. While we are happy to submit claims whenever possible, your insurance company (not your healthcare provider) determines your benefits and financial responsibility.
Original Medicare
Select BlueCross BlueShield of South Carolina plans
Insurance participation is based on the patient’s specific plan and provider network
Pelvic Prime may be in-network with certain BlueCross BlueShield of South Carolina plans, including some plans administered through:
BlueCross BlueShield of South Carolina
Preferred Blue®
Federal Employee Program, or FEP
South Carolina State Health Plan
Certain Medicare Advantage plans
Pelvic Prime is not in-network with every BlueCross BlueShield plan. Out-of-state plans, employer-specific networks, Medicare Advantage plans, and plans administered by Anthem or another BlueCross BlueShield company may use different provider networks.
For example, an Anthem BlueCross BlueShield plan issued in Georgia may not include Pelvic Prime as an in-network provider, even though the insurance card displays the BlueCross BlueShield logo.
Before your first appointment, we strongly encourage you to contact your insurance company to verify your physical therapy benefits.
Helpful questions to ask include:
* Is Pelvic Prime Physical Therapy in network with my plan?
* Is physical therapy covered under my policy?
* Do I need a referral or prior authorization?
* Does my deductible apply?
* What is my copayment or coinsurance?
* Are there visit limits?
* Does my plan cover telehealth physical therapy, if applicable?
Only your insurance company can determine your specific coverage and financial responsibility. Because insurance benefits vary by plan and can change at any time, Pelvic Prime does not verify insurance benefits or estimate patient financial responsibility.
Your insurance company is the only source that can accurately confirm:
* Whether services are covered
* Your deductible
* Copayments
* Coinsurance
* Visit limits
* Referral requirements
* Prior authorization requirements
* Telehealth benefits
* Out-of-network benefits
While Pelvic Prime can submit claims to your insurance when possible, submission of a claim does not guarantee payment. You are responsible for any portion of your care that is not paid by your insurance company.
If you have questions about our billing process or the information your insurance company requests, our Billing Department is happy to help. We can explain our billing procedures, but we cannot determine or guarantee your insurance benefits.
No! You do not need a referral to be treated by a physical therapist in the state of South Carolina. After your first visit, we fax over the evaluation paperwork for your doctor's signature.
Submitting a superbill receipt typically involves providing detailed information about the medical services received so that you can seek reimbursement from your insurance company. Here are general instructions on how to submit a superbill receipt:
Request a superbill from your healthcare provider. A superbill is a detailed invoice that includes the services provided, diagnosis codes, and other relevant information.
Carefully review the superbill to ensure that all the information is accurate and complete. Check for the date of service, provider information, services rendered, and any applicable codes.
Verify with your insurance provider that the services listed on the superbill are covered under your plan. Some services or procedures may not be eligible for reimbursement.
Some insurance companies may require you to fill out a specific claim form in addition to submitting the superbill. Obtain and complete any necessary forms provided by your insurance company.
Make photocopies of the completed superbill and any additional claim forms. Keep the copies for your records.
Send the superbill and any required claim forms to your insurance company. This can often be done through an online portal, by mail, or by fax. Check with your insurance provider for their preferred method of submission.
In some cases, it may be helpful to include a cover letter explaining any additional information, special circumstances, or details that you want the insurance company to consider.
Keep a copy of all documents submitted, including the superbill, claim forms, and any correspondence with the insurance company. This will be important for tracking the status of your reimbursement.
After submitting the superbill, follow up with your insurance company to ensure they received the documents and to inquire about the status of your claim. Be persistent in following up until the matter is resolved.
If your claim is denied or there are issues with the reimbursement, work with your healthcare provider and insurance company to address and resolve any discrepancies.
Remember that the specific process and requirements may vary depending on your insurance provider. Always consult with your healthcare provider and insurance company for any specific instructions or forms they may require.
A superbill is a detailed invoice created by healthcare providers to document the services rendered to a patient. In this guide, we'll walk you through the steps to ensure a smooth and efficient reimbursement experience.
You will find all of your essential information at the top of the superbill. This will include patient details (name, date of birth, address, and insurance information), and provider information.
You will find all of the relevant diagnosis codes at the top of the superbill next to your name.
The services codes are found next to the date of service.
This will also include all of the Modifier Codes. Modifier codes provide additional information about the services rendered. Common modifiers include those indicating multiple procedures, bilateral procedures, or services performed by different providers.
To strengthen your reimbursement claim, attach any necessary supporting documents. These may include lab results, imaging reports, or any other relevant documentation that validates the services provided. We can also send you a copy of the notes from your therapy session.
Once the superbill is complete, submit it to your insurance company. This can typically be done electronically through the insurance portal or by mail. Some insurance companies may have specific submission requirements, so be sure to follow their guidelines closely.
It's crucial to keep a copy of the submitted superbill and all supporting documents for your records. This documentation serves as proof of the services provided and can be useful for tracking the reimbursement process.
After submitting the superbill, regularly follow up with the insurance company to check the status of the reimbursement. This may involve contacting the insurance provider, checking the online portal, or reviewing any correspondence from the insurance company.
If the reimbursement is denied or if there are discrepancies, address them promptly. Review the denial reasons, correct any errors, and resubmit the superbill if necessary. Clear communication with the insurance company is key to resolving issues.