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Forms

The State of Texas requires that all patients needing physical therapy have a valid referral form prior to treatment. Referrals may be obtained from your primary care physician (PCP), a specialist or a chiropractor, and should be dated within 90 days of your appointment.

If you have a BCBS HMO plan, your PCP will have to file a referral with BCBS in order for your coverage to be valid.

FORMS

Please print and fill out the forms prior to your first appointment.  If you have problems with the files or any questions about the forms, please call us at 512-852-8434. We’re glad to help!

ALL PATIENTS

YPB New Patient Forms (Print & fill out all pages)

NEW PATIENT QUESTIONNAIRE

CHOOSE FORM FOR PERTINENT BODY PART:

NECK INDEX - Cervical, Headaches, Dizziness

DASH - Arm, Shoulder, Wrist & Hand Disabilities

BACK INDEX - Back, Ribs & Thorax

LEFS - Lower Extremities (Hips, Legs, Knees, Feet)

ABC – Parkinson’s, Balance issues

INSURANCE

We participate with most area insurance plans, and as a courtesy, we are happy to check your benefits for you before your first appointment. Also, we highly recommend that you check with your insurance plan yourself prior to making an appointment to ensure that your plan considers us a participating provider and what coverage they provide for physical therapy. It’s important to remember, however, that verification of benefits by Your Personal Best PT is not a guarantee of payment by your insurance company, and that by law you are responsible for payment of your account.

Having a hard time understanding insurance terms?  These are some of the most common terms you will hear:

Deductible

This is a dollar amount that you must meet before your insurance will start to pay any portion of a covered service. For example, if you have a $1000 deductible, even if your insurance says it will pay a portion of a covered service, you will still have to pay the first $1000 in charges for your care.  The amount you will pay each visit depends on the contracted rate with your insurance payer.  We can only give you an approximate amount.

Co-Insurance

Your health insurance company has agreed to pay a portion of the expense of a covered service. For example, if they pay 80% of a covered service, you will pay 20% of the fee for the service. In most cases, this only applies after the deductible has been met.

Copay

Some companies waive the deductible and specify only a copay for each visit.  Some companies specify different copays for the first visit versus subsequent visits.

Out of Pocket Maximum

If you have a deductible to meet, you may also have an out of pocket maximum, which is a dollar amount you meet in addition to the deductible. It may or may not be the same amount as the deductible. The good news is that once you have met the out of pocket maximum amount, most insurance coverage is 100% for your care.

Maximum Benefit

Medicare patients have a dollar amount maximum benefit for their coverage, which may change from year to year. Usually this is enough to cover all necessary care.  Some other insurance plans may also specify a maximum dollar amount in benefits, or a maximum number of visits.

Out of Network Benefits

Even if our office is not in network with your health insurance company, some insurance carriers will cover physical therapy services at an out of network rate.

We work with the following insurance companies.  If yours is not on the list, call us at 512-852-8434 and we will be glad to contact them about possible coverage.

  • Aetna
  • AARP
  • MultiPlan
  • TriCare
  • Medicare
  • Align
  • Cigna/ASH
  • PHCS
  • TriWest
  • Workers Comp
  • Blue Cross Blue Shield
  • Humana
  • Scott & White
  • United Healthcare
  • PIP

 

NEED HELP BUT DON’T HAVE HEALTH INSURANCE COVERAGE?

Here at Your Personal Best PT, we want you to have the help you need.  If you don’t have insurance, or if you have exhausted your health insurance coverage, we can still see you.  We offer payment plans to cash-paying patients. Call or email for details!