Patient Care Management
- Good standing: Patients in good standing are respectful and professional, cooperative with treatment, compliant with prescribed home exercise program, and Therapist instruction. No outstanding balance from late cancellations/no-shows.
- 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.
- Failure to respond to ESPT communication: When we notice repeated cancellations or a missed appointment, we will likely call you to confirm your next appointment and also ask if you plan to continue care. If you do not respond to our requests, we may close your case and cancel remaining appointments. Any late cancellations or no-show fees incurred will be your responsibility and all balances will need to be paid up-to-date in order to resume care.
- Patient cooperation with treatment plan: 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.
- 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.
- Initial Examination: $150
- Initial examinations include 25-minute examination by physical therapist followed by additional 15-20 minutes for instruction in exercise. Total time 35-50 minutes pending nature of condition
- Initial examinations are performed for single body region. Examinations for multiple body regions will require separate examinations
- Follow-Up: 30 minute – $75; 60 minute – $125
- 30-minute follow-up: $75 includes 20-30 minutes with physical therapist or physical therapist assistant and 0-10 minute instruction in exercise with physical therapy aide. Total time 30 minutes.
- 60-minute follow-up: $125 includes 20-30 minutes with physical therapist or physical therapist assistant and 30-40 minutes with physical therapist aide for exercise instruction or modalities. Total time 60 minutes.
Use of Insurance
- Auto Insurance: We do not accept auto insurance – if you have endured an injury from a motor vehicle accident, you have the option to pay out-of-pocket and a detailed receipt of services can be given to you in order to submit for reimbursement by the auto insurance.
- Accepted Insurances: We accept major PPO insurances including Aetna, Blue Shield, Blue Cross, United Health Care, Health Net. We do NOT accept Cigna, MediCal (exception MediCal w/ Medicare), HMO plans, Alameda Alliance, Community Health Center Network
- Insurance Authorization Policy: Select insurance plans require pre-authorization of physical therapy office visits. This may require you to complete an outcome measures survey and authorization request form which will be submitted on your behalf by ESPT. Elite Sports Physical Therapy will only provide PT services within the approved authorizations. If authorization is in progress or has not been approved, you have the option to continue care out-of-pocket or discontinue treatment.
- Medicare: We accept Medicare PPO plans only
- Medicare billing and insurance: Patients are able to use Medicare as their primary insurance to cover 80% of their billing claim and use a secondary insurance to cover the remainder 20%. There is a small deductible of $183.
- Medicare Therapy Cap Policy: Medicare’s Therapy Cap is $2010.00 for physical therapy and occupational therapy services during the calendar year. If physical therapy services are required beyond the therapy cap for surgical post- rehabilitation – we apply the appropriate billing modifiers to request for approval, however there are no guarantees for Medicare coverage. Any unpaid balances will be placed under the responsibility of the individual.
- Maximal Physical Therapy Visit Limit: Elite Sports Physical Therapy will provide physical therapy services within a person’s maximum physical therapy visit limit only. We will not be responsible for requesting additional visits outside of maximum PT visit benefits and we do not perform peer reviews for authorization requests. Patients requesting to receive treatment beyond their insurance’s PT maximum visit benefits for physical therapy will need to continue the remainder of their care out-of-pocket. Receipts can be available upon request for you to submit billing claims to insurance for reimbursement, if available by insurance – please check with your individual insurance.
- Traveler’s Insurance: We do not accept Traveler’s Insurance. If you wish to receive PT services at our facility – you will need to pay out-of-pocket.
- Worker’s Comp: We accept workers’ comp and require authorization for treatment prior to scheduling initial examination and follow-up appointments. We have a strict attendance policy with workers’ comp and patients with poor attendance or are non-compliant will be discharged from ESPT care. Any no-show fees incurred will be the individual’s responsibility and will have to abide by ESPT’s no-show/late cancellation policy.
- 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
- General Appointment reminders: Appointment reminders are a courtesy only and shall not be relied on as errors may happen between software system and phone carrier. Patients are ultimately responsible for management of treatment schedule. We recommend to keep an updated copy of your schedule and enter your treatment schedule into your personal phone/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: Courtesy email reminders may be delivered from ESPT’s front desk email address to provide patients with an overview of upcoming scheduled appointments.