Care Access & Use of Services
Under California law, you may continue to receive direct physical therapy treatment services for a period of up to 45 calendar days or 12 visits, whichever occurs first, after which time an updated prescription is needed.
A physical therapist may continue providing you with physical therapy treatment services only after receiving, from a person holding a physician and surgeon’s certificate, issued by the Medical Board of California or by the Osteopathic Medical Board of California, or from a person holding a certificate to practice podiatric medicine from the California Board of Podiatric Medicine and acting within his or her scope of practice, a dated signature on the physical therapist’s plan of care indicating approval of the physical therapist’s plan of care and that an in-person patient examination and evaluation was conducted by the physician and surgeon or podiatrist. With your written authorization, your physical therapist shall notify your physician and surgeon, if any, that he/she is treating you.
I further authorize Elite Sports Physical Therapy to release to appropriate agencies, any information acquired in the course of my or the above named patient’s examination and treatment.
I acknowledge that Elite Sports Physical Therapy reserves the right to refuse service to anyone choosing not to abide by facility policies or deemed to be disruptive to other patients or staff members. Elite Sports Physical Therapy does not discriminate and will not deny service to individuals based on any other reason.
- All outstanding balances including late cancellation/no shows paid at next scheduled appointment. Treatment balances must be paid in full within one month to the date of statement.
- Patients must maintain good standing in order to receive treatment at ESPT.
Poor standing: Patients who are not respectful, behavior is unprofessional, and negative towards any member of the ESPT staff or to any patients. Patients who are not cooperative with treatment, patients with overdue balances will not be tolerated. Patients exhibiting such behavior may be subject to delay of treatment, discharge from treatment, and/or exited from ESPT.
Discontinuation of Care: If for whatever reason you need to discontinue PT services, it is your responsibility to notify ESPT as soon as possible. You will be responsible for any no-show or late cancellations fees acquired.
Patient cooperation: We expect all our patients to cooperate in treatment, follow prescribed exercises, and follow medical instruction in order to progress and improve. Failure to follow HEP/instructions will result in minimal to no progression.
Updating contact information: Please verify all contact information including legal name, home address, phone number, and email address. Any changes to personal information must be notified to front desk.
ESPT does not provide telehealth physical therapy services.
We believe the best care is delivered in person and in real time, where our therapists can fully evaluate movement, apply hands-on techniques, and ensure safe, effective outcomes.
Cancellations: We ask all patients to cancel in advance as a courtesy to other patients.
- Insurance (PPO & Medicare): Cancel ≥24 hours before your visit (phone, voicemail, email, or at a prior appointment).
- Cash-Pay PT & Performance Training: Cancel ≥48 hours before your visit (same methods as above).
Late Cancellation
- Insurance: Cancellation with <24 hours’ notice → $75 late cancellation fee.
- Cash-Pay/PT & Performance: Cancellation with <48 hours’ notice → full session fee charged.
Cancellation within 48 hours of appointment: ESPT has a strict late cancellation policy. A cancellation made within 48 hours notice will result in a $75 late cancellation fee. Late cancellation fee must be paid at time of next visit in order to keep your next scheduled visit. Work-related reason for late cancellation is still subject to late cancellation policy – patients may ask their employer if reimbursement is available.
No-show/Missed Appointments:
- Insurance: $125 no-show fee.
- Cash-Pay/PT & Performance: Full session fee forfeited (no refund or reschedule).
Consecutive No-Shows:
Any 2 no-shows OR 3 late cancellations within 6 months may result in same-day-only scheduling or discharge from non-urgent care. Even with documentation, repeated disruptions may still incur a fee at the clinic’s discretion.
Late Arrival to Appointment:
- Insurance (PPO & Medicare):
- 0–9 min late: You will be seen; session ends at the scheduled time (minutes cannot be made up).
- 10+ min late: Appointment rescheduled; $75 late cancellation fee applies.
- Cash-Pay PT & Performance Training:
- 0–29 min late: Session shortened; billed at full fee.
- 30+ min late: Session forfeited; billed at full fee.
Insurance & Financial Policies
Accepted Insurances
We accept most major PPO insurance plans and Medicare PPO.
We do NOT accept:
- Health Net
- Cigna (out-of-network only)
- Medi-Cal (except Medi-Cal with Medicare)
- HMO plans
- Alameda Alliance
- Community Health Center Network
All insurance-based physical therapy at ESPT must meet medical necessity guidelines set by your insurance provider and federal regulations.
- Care is authorized only when treatment is considered skilled, reasonable, and necessary to improve function, reduce impairment, or prevent decline.
- When you reach a point where skilled therapy is no longer required, or if progress has plateaued, insurance coverage may end—even if symptoms remain.
- Continued care beyond insurance limits may be arranged on a cash-pay basis.
Elite Sports Physical Therapy commits itself to legal and ethical billing practices. All billing follows the Rule of 8’s for private parties or the Medicare 8-minute rule. The Rule of 8’s states that one unit can be billed when at least 8 minutes of a 15-minute service is performed for that service.
All patients are financially responsible for services provided by ESPT.
- Insurance Visits: Patients are responsible for all co-pays, deductibles, co-insurance, and any non-covered services. These will be charged to the credit card on file once claims are processed.
- Cash-Pay PT & Performance Training: All services must be paid in full at the time of scheduling. Prepaid sessions are non-refundable.
- Packages & Memberships: Prepaid packages and memberships are non-refundable, non-transferable, and may carry expiration dates as noted at time of purchase.
- Outstanding Balances: Any unpaid balances, including late cancellation or no-show fees, must be cleared before additional appointments can be scheduled.
Effective October 1, 2025: ESPT prefers a credit card on file for insurance-based PT to simplify billing. If you decline, copays, deductibles, and coinsurance must be paid in full at each visit before being seen. Cash-pay and performance services must be paid at the time of scheduling. All cards are stored securely in a PCI-compliant system, and ESPT staff cannot access your full card number.
Under federal law, patients who are uninsured or choose to self-pay are entitled to a Good Faith Estimate (GFE) of expected charges. You may request a written estimate before scheduling or at any time during care. This estimate does not guarantee insurance coverage and actual costs may vary based on services provided.
Wellness, recovery, performance training, and other elective cash-pay services are not covered by insurance and are billed at ESPT’s published cash rates. These services are voluntary, non-covered, and payment is required upfront at scheduling.
Attendance & Scheduling
Scheduling Appointments:
Appointments may be scheduled in person, over the phone, or by email. All patients are scheduled one appointment at a time to ensure consistent attendance.
Re-Scheduling Appointments:
- Insurance-Based Care (PPO & Medicare): No penalty if rescheduled with more than 24 hours’ notice.
- Cash-Pay PT & Performance Training: No penalty if rescheduled with more than 48 hours’ notice.
- Same-day appointment changes must be re-scheduled within the same day; otherwise, it will be considered a late cancellation.
Appointment reminders:
Appointment reminders are sent by text message the business day before and by email.
- No appointment changes will be accepted via text.
- Reminders are a courtesy only; patients remain responsible for keeping track of their own treatment schedule. We recommend maintaining a copy of your schedule and entering all appointments into your personal calendar.
Text Reminders: Courtesy text reminders are delivered 3 days prior to scheduled appointment via Luma Health Software. The patient has the option to confirm appointment or cancel appointment. Any cancellation within 48 hours of scheduled appointment time will be subject to the late cancellation policy.
Email Reminders: Email reminders are sent for your next scheduled appointment. These are delivered by the end of the business day on the day of your last attended appointment (when the next appointment was booked). This ensures you have a written confirmation of your upcoming visit.
Consecutive Cancellations/No-Shows:
If repeated late cancellations or no-shows occur:
- Applicable fees will be charged to your Credit Card on File (CCOF).
- More than 2 late cancellations or no-shows within 6 months may result in a change to same-day scheduling only or to cash-pay scheduling, which requires full payment upfront at the time of booking and is non-refundable if forfeited.
- If you fail to respond to ESPT outreach regarding your attendance, your case may be closed and all future appointments cancelled. All outstanding fees must be paid before care can resume.
Cancellations: We ask all patients to make cancellations 48 hours in advance as a courtesy to other patients who may be interested in the appointment. Cancellations can be made at an earlier appointment, or by phone/email.
Cancellation within 48 hours of appointment: ESPT has a strict late cancellation policy. A cancellation made within 48 hours notice will result in a $75 late cancellation fee. Late cancellation fee must be paid at time of next visit in order to keep your next scheduled visit. Work-related reason for late cancellation is still subject to late cancellation policy – patients may ask their employer if reimbursement is available.
No-show/Missed Appointments: We have a strict no-show policy which results in a $75 fee for a missed appointment. You must pay the no-show fee at time of your next appointment in order to keep your next scheduled appointment. Missed appointments may be pardoned due to sickness with doctor’s note only.
Consecutive No-Shows: Two consecutive no-shows will result in an automatic discharge from care, including $150 accumulated no-show fee and you may be placed under poor clinic standing until all outstanding balances are paid up-to-date. In order to resume PT treatment and return to good standing, all outstanding fees must be paid.
Late Arrival to Appointment: Late arrival constitutes 15 minutes beyond scheduled appointment time. It is per the discretion of the physical therapy provider to continue with treatment. Arrival 20+ minutes beyond scheduled appointment time will result in an appointment forfeit and $75 fee for missed appointment.
Contacting The Clinic: We do our best to answer all phone calls, however we give priority attention to patients in the clinic who require assistance. Please leave a voice message or email us at frontdesk.ESPT@gmail.com and we will return your call/email. We will not be able to return your call unless a message is placed.
Contact information:
- Phone number: 510-656-3777
- Fax number: 510-656-3750
- Email: Frontdesk.ESPT@gmail.com
ESPT reserves the right to discontinue care when necessary, including but not limited to:
- Non-compliance with attendance or treatment plan
- Repeated no-shows or late cancellations
- Failure to pay outstanding balances
- Safety, behavioral, or ethical concerns
When appropriate, patients will be provided with referral options to ensure continuity of care.
Privacy & Records
Our Notice of Privacy Practices describes in more detail how your protected health information may be used and disclosed and how you can access your information.
Uses and disclosures for Treatment: With your agreement, we will make uses and disclosures of your PHI as necessary for treatment. Our staff that is involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to your determine your course of treatment that may include procedures, tests, referral to appropriate providers, medical history, etc. We may disclose your PHI to another on of your treatment providers in the community, unless the provider is not currently providing treatment to you and you direct us in writing not make the disclosure.
Uses and Disclosures to health Care Organizations: With your agreement, we will use and disclose your personal health information as necessary, and as permitted by law, for our health care operations, which may include clinical improvement, professional peer review, business management, accreditation, and licensing, etc. For instance, we may use and disclose your PHI for purposes of improving the clinical treatment and patientcare of ESPT.
Individuals Involved in Your Care: Unless you notify us in writing of your desire to restrict disclosure, we may from time to time provide relevant PHI to designated family, friends, and others who are involved in your care or in payment of your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest; we may share limited PHI with involved individuals without your approval.
Business Associates: Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, outcome data collection, legal services, etc. At times it may be necessary for us to provide your PHI to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.
Train Staff and Students: We may use and disclose your information to teach and train staff and students. One example of this is when we review your PHI with physical therapy students/interns.
Other Uses and Disclosures: We are permitted and/or required by law to make certain other uses and disclosures of your PHI without your consent or authorization for the following:
- Any purpose required by law,
- Public health activities, such as required reporting of disease, injury, birth, and death, or required public health investigations,
- If we suspect child abuse or neglect; if we believe you to be a victim of abuse, neglect, or domestic violence
- To the Food and Drug Administration (FDA) to report adverse events, product defects, or to participate in product recalls,
- To your employer when we have provided health care to you at the request of your employer,
- To a government oversight agency conducting audits, investigations, or civil criminal proceedings,
- Court or administrative ordered subpoena or discovery request,
- To law enforcement officials as required by law to report wounds and injuries and crimes,
- To coroners and/or funeral directors constituent with law,
- If you are a member of the military, we may also release your PHI for national security or intelligence activities, and
- To workers’ compensation agencies for workers’ compensation benefit determination.
Rights that you have regarding your Personal Health Information (PHI)
- Access to Your PHI: You have the right to copy and/or inspect much of the PHI that we retain on your behalf. All requests for access must be made in writing and signed by you or your legal representative. You may obtain a “Patient Access To Personal Health Information Form” form the front office person.
- Amendments to Your PHI: You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests, must in writing, signed by you or your legal representative, and must state the reasons for the amendment/correction request. If an amendment or correction request is made, we may notify others who work with us if we believe that such notification is necessary.
- Accounting for Disclosures of Your PHI: You have the right to receive an accounting of certain disclosures made by us of your personal health information. Requests must be made in writing and signed by you or your legal representative. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12-month period. You will be notified as the fee at the time of your request.
- Restrictions on Use and Disclosure of Your PHI: You have the right to request restrictions on uses and disclosures of your PHI for treatment, payment, or health care operations. We are not required to agree to your restriction request, but will attempt to accommodate reasonable request when appropriate. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction by sending such termination notice to Elite Sports Physical Therapy.
- Workers’ Compensation: Medical information generated for services provided to Workers’ Compensation patients is not covered by HIPAA. As such, Worker’s Compensation patients do not have the right to restrict, amend, or request an accounting of their PHI generated for purposes of Worker’s Compensation
- Complaints: If you are concerned that your privacy rights have been violated or you disagree with a decision we made about access to your records, you may file a complaint in writing with us at Elite Sports Physical Therapy. You may also file a complaint with the Secretary of the U.S. Department of Health and human Services in Washington D.C. in writing within 180 days of violation of your rights. There will be no retaliation for filing a complaint.
Patients may request copies of their medical records, treatment notes, or documentation summaries by submitting a written request. ESPT will provide requested records within 14 business days in accordance with California law. A reasonable administrative fee may apply for printing, copying, or mailing records.
Safety & Compliance
ESPT follows all CDC and OSHA guidelines to maintain a safe clinic environment. Treatment areas and equipment are cleaned regularly, and infection control protocols are in place to protect patients and staff.