Insurance Coverage
Navigating physical therapy benefits shouldn't be a hurdle in your recovery journey. At Apex Physical Therapy and Performance, we act as your advocate, working directly with insurance carriers to verify your coverage before your first session. Our goal is to provide elite-level care while ensuring your financial path is as clear as your treatment plan.
Accepted Insurances
Blue Cross Blue Shield
Coverage for most PPO/POS programs
Aetna & Cigna
Participating in various commercial and employer-sponsored PPO healthy choice plans.
Medicare Part B
Direct billing for standard Medicare and select Medicare Advantage partnerships.
United Healthcare
We also work with UnitedHealthcare and provide superbills for out-of-network reimbursement.
Other Out-of-Network Plans
Understanding Your Benefits
Deductibles
The annual amount you pay out-of-pocket for covered medical services before your insurance plan begins to pay. At Apex, we help you track this progress so there are no surprises.
Co-pays
A fixed dollar amount you are responsible for paying at the time of each visit. This amount is determined by your specific insurance policy and collected during check-in.
Co-insurance
Once your deductible is met, coinsurance is your share of the costs for a session, typically calculated as a percentage (e.g., 20%). Your insurance covers the remaining portion.
Out-of-Pocket Maximum
The absolute limit on what you pay for covered services in a plan year. After reaching this limit, your insurance plan pays 100% of the allowed amount for covered therapy.
Referrals & Pre-Auths
Some policies require a doctor's referral or clinical authorization before we begin. Our billing team handles the paperwork to ensure your care is approved and covered.
Transparent Pricing
We provide sample self-pay rates for evaluates and sessions. Please note that final costs may depend on your individual insurance plan benefits and pre-authorizations.
Physical Therapy Evaluation
$150
- 60-minute comprehensive assessment
- Clinical diagnosis & movement analysis
- Personalized performance roadmap
- Initial manual therapy intervention
Follow-Up Treatment
$130
- 45-minute focused therapy session
- Advanced manual therapy techniques
- Performance strengthening protocols
- Progress data and roadmap updates
Performance Package
$110/visit
- 10 session package at total price of $1100
- Mobility & stability optimization
- Injury prevention programming
- Sport-specific movement coaching
Straightforward Payment Options
We aim to make the financial aspect of your recovery as seamless as the therapy itself. We accept all major credit cards (Visa, Mastercard, American Express, and Discover). To help you maximize your health investments, we also welcome Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA). Personal checks and digital payments are also accepted for your convenience.
When is payment collected?
- At Time of Service: Copays and self-pay rates are due at the beginning of each visit to keep your billing current.
- Post-Insurance Processing: Co-insurance and deductibles are billed once your insurance carrier processes the clean claim.
- Performance Packages: For specialized performance training bundles, full payment is collected at the time of the initial assessment to lock in your discounted rate.
Frequently Asked Questions
Is physical therapy covered by my insurance?
Yes, most major insurance plans cover physical therapy. At Apex, we are currently in-network with several leading providers. We recommend reviewing our Insurance Overview or contacting us directly to verify your specific plan's coverage and requirements.
What if Apex is out-of-network for my provider?
We frequently work with patients utilizing out-of-network benefits. In these cases, we provide you with a detailed 'superbill' that you can submit to your insurance company for potential reimbursement. Many patients find that their out-of-network coverage is quite competitive.
What should I expect during my first session?
Your first visit is a comprehensive 60-minute evaluation. We will review your medical history, discuss your injury or performance goals, and perform a detailed movement screening. We also take this time to review your benefit verification so you have total clarity on costs moving forward.
Do I need a doctor's referral to start therapy?
New Jersey is a Direct Access state, which allows you to begin physical therapy without a physician's referral. However, some specific insurance plans still require a referral or pre-authorization for reimbursement. We can help you determine if your plan has these requirements.
When and how is payment collected?
Payment is collected at the time of your session. This includes insurance co-pays, co-insurance, or self-pay fees. For your convenience, we accept all major credit cards, HSA or FSA cards, and checks.
Will you verify my benefits before I arrive?
Absolutely. We offer a complimentary benefit verification for all new patients. This allows us to share your expected deductibles, co-pays, and out-of-pocket maximums upfront, so there are no surprises regarding your healthcare investment.
Contact Billing
Navigating insurance can be complex, but it doesn't have to be. Our billing specialists are ready to help you understand your benefits and manage your payments with total transparency.
T: (551) 360-0053
E: apex.pt.nj@gmail.com
Your focus should be on recovery and performance. We take care of the paperwork, coordinating directly with providers to ensure you maximize your eligible coverage.