(Effective January 22, 2024)
We are pleased you have chosen Origin Physical Therapy (FL), PLLC, Origin Physical Therapy (CA), Inc., Clampett Physical Therapy (NY), PLLC, Sullivan Physical Therapy, LLC, Origin Physical Therapy (NJ), LLC, Fiat Physical Therapy, LLC, To The Core Physical Therapy & Conditioning, LLC and / or The Origin Way, Inc. (individually or collectively referred to herein as “Origin”) for your needs.
We bill your personal insurance carrier solely as a courtesy to you. We require that you pay the estimated amount of what you owe (“Patient Responsibility”) at every appointment. It is not a guarantee of the amount you owe, it is only an estimate. Furthermore, if your insurance coverage includes virtual visits coverage, we endeavor to bill virtual visits at the same rate as in-person visit; however, we cannot guarantee it. You are responsible for your bill, so if you would like to be certain of your coverage and patient responsibility, we encourage you to verify with your insurance company prior to your appointments.
In the event that your insurance company requests a refund of payments made to us, you may be responsible for any amounts refunded to your insurance company. If any payment is made directly to you by the insurance company for Services billed by us, you recognize an obligation to promptly remit the payment(s) to us. If formal collections procedures become necessary, you may be responsible for additional costs incurred.
We will review your estimated insurance benefits with you at the time of your visit. Your benefits are quoted to us by your insurance carrier, and we assume no liability for any errors made by your insurance carrier in this estimate. We will attempt to obtain authorization for additional appointments necessary once insurance coverage for the initial appointments ceases (including steps necessary to appeal a denial); however, this does not guarantee that your insurance will accept the request to authorize additional appointments. You are also responsible for keeping track of appointments covered by your insurance policy. You will be responsible for any visits beyond the visits authorized by your insurance carrier.
Balance Due / Self-pay / Cash Rates
You may be considered a self-pay patient and responsible to pay our direct to patient rates, and your balance owed maywill due in full, if your:
- Insurance claims are denied for any reason
- Insurance coverage is inactive
- Insurance company doesn’t process your payment within 60 days
- Insurance company does not authorize visits
- Insurance company does not verify your eligibility
- Treatment exceeds the coverage of your insurance policy
- Insurance does not cover our Services
- Insurance is out of network
- Prescription (Rx), referral or Plan of Care is not provided in timely manner
- Insurance will not cover multiple appointments in one day.
Receiving care from providers outside of your insurance plan provider network usually may result in higher out-of-pocket costs for you. Origin encourages you to contact your insurance plan to confirm that Origin is a provider within your plan’s network before engaging with Services from a Professional.
Each returned check will incur a $30 returned check fee and an alternative form of payment will be required for all subsequent payments.
Assignment of Insurance Benefits
You hereby authorize Origin to furnish information to insurance carriers concerning this treatment and assign all payment for the Services.
Workers’ Compensation Claims
If you claim Workers’ Compensation benefits and are subsequently denied such benefits, you may be held responsible for the total amount of charges for Services rendered by a Professional.
Flexible Spending Account (FSA) / Health Savings Account (HSA)
Origin accepts payments from FSA/HSAs. Payments from FSA/HSAs will be reflected as “unapplied” until the claim has been processed through insurance.
Late Cancellation & No-shows
Our goal at Origin is to provide every patient with high quality care and attention. It is important that patients try to attend their appointments to achieve their treatment goals. In order to provide this care, we will make our best efforts to accommodate each patient’s schedule and reserve appointment slots accordingly.
We understand that life happens, and you may need to cancel or reschedule your appointment. In the event that you’re unable to make your scheduled appointment, we do require notice at least 24-hours prior to your appointment. This will allow us to find a different time for you to continue your treatment while also allowing us to provide care to another patient who may be waiting to be scheduled.
The charge for no-show, cancellation, or for rescheduling an appointment, including first visit, without at least 24-hour notice (each a “Late Cancellation”) is $50 (“Cancellation Fees”). After a three (3) late cancellations and/or no-show appointments, the Late Cancellation Fee will increase to $75 for any subsequent late cancellation and/or no-show appointments. The Cancellation Fees cannot be billed to insurance and will need to be paid directly by the patient prior to receiving additional Services.
A Late Cancellation is an appointment cancellation made less than 24-hours before your appointment, appointments rescheduled less than 24-hours prior to your appointment, or if you fail to appear for your scheduled appointment, or are more than 20 minutes late to your appointment. If you show up to your appointment more than 20 minutes after it was scheduled to start, you will be subject to the Cancellation Fees.
We try to send automated email confirmations and text reminders; but it is your responsibility to track your schedule in order to cancel or reschedule in a timely manner. Missing an appointment due to a missed email or text reminder does not exempt you from Cancellation Fees.
We require all patients to have a credit card on file at their first appointment. Cancellation Fees will be automatically charged. These terms serve as notice of our Cancellation Fees.
Origin also reserves the right to update this policy periodically without notice. The most current policy will always be made available on our website, at our locations, and upon request.
Modification & Termination
You or Origin may terminate your access to the Services. Origin may also suspend or terminate your access to the Services. If you want to terminate your access to the Services, please contact Origin at firstname.lastname@example.org and we will complete your request.
Origin may suspend or terminate your access to the Services for any reason it deems appropriate at any time, including, but not limited to, a belief that your conduct or your use of the Service violates any of these terms or applicable laws, or is otherwise harmful to the interests of Origin or its providers. In addition, Origin also may place limits on, modify, suspend, or terminate your access to the Service generally or in response to a legal or regulatory change. If your access to the Services is terminated, Origin will have no further obligation to provide you with access to the Services, except to the extent that Origin may provide you with access to your health records, or our providers are required to provide you with continuing care.