At Stacks Physio, we provide elite, one-on-one sports and orthopedic physical therapy. To ensure our focus remains entirely on your recovery and performance—undictated by insurance company restrictions—we operate as an Out-of-Network (OON) provider.

Payment Options

We offer two pathways for payment: Self-Pay or Out-of-Network Insurance Submission.

Self-Pay (Out-of-Pocket)

This is the most straightforward option. You pay at the time of service, and no claims are sent to your insurance. Rates vary by therapist. Upon request, we can provide a Superbill (an itemized receipt) for you to submit to your insurance for direct reimbursement.

Out-of-Network Insurance Submission

If you have a PPO or a plan with out-of-network benefits, we offer the convenience of submitting claims directly to your insurance provider on your behalf. This service is designed to remove the administrative burden from you, allowing you to focus entirely on your recovery.

• How it works: We handle the technical coding and claim submission through our billing system.

• Reimbursement: Your insurance provider processes the claim based on your out-of-network coverage.

• Cost Protection: While we bill insurance using standardized "Usual and Customary" rates (see below), your personal financial responsibility is always protected and capped by our Variable Copay Policy.

Important: Insurers That Pay Patients Directly

Most insurance companies (including Anthem Blue Cross Blue Shield, Aetna, Cigna, and UnitedHealthcare) send reimbursement checks directly to the patient, not to our clinic.

Because we provide the service but the insurance pays you, we have a clear policy to ensure our providers are compensated:

• Notification: We will notify you when we receive confirmation that your insurance has issued a reimbursement check to your home.

• The 14-Day Rule: Once notified, you have 14 days to remit that payment to Stacks Physio (via check, Venmo, or Zelle).

• Auto-Charge: If the balance is not settled within 14 days, the credit card on file will be automatically charged for the balance due.

Pro Tip: Set Up Direct Deposit To avoid the risk of checks being lost in the mail and to receive your funds faster, we highly recommend logging into your insurance provider's member portal (e.g., Aetna Navigator, myCigna, etc.) and signing up for Direct Deposit or Electronic Funds Transfer (EFT). This ensures your reimbursement is deposited securely into your bank account as soon as the claim is processed.

Understanding Pre-Deductible Rates

If you have not yet met your annual out-of-network deductible, you will be responsible for the full cost of the session until that deductible is satisfied. Please note that the rate for sessions submitted to insurance is slightly higher than our Self-Pay rate to offset the costs of professional billing administration and claim management.

Once your deductible is met, your cost per session will transition to the Variable Copay model described below.

Variable Copay & Cost-Sharing Policy

When your insurance benefits are verified prior to treatment, we provide an estimated coinsurance or copay amount based on your specific plan.

Why We Always Collect a Copay

Per your agreement with your insurance provider, you are contractually responsible for a portion of the cost of your care (coinsurance/copay). We are required to collect this payment for every session, unless you have reached your Out-of-Pocket Maximum for the year. Even if the insurance reimbursement meets our minimum therapist rate, we must still collect your designated cost-sharing amount to remain compliant with insurance regulations.

Adjustments to Your Copay

Your initial estimate is subject to change once the claim is processed and actual reimbursement rates are determined. If the combined total of the insurance reimbursement and your paid copay falls below our therapist’s minimum rate, your copay may be adjusted upward to meet the difference.

• Shaun’s Minimum Rate: $215 per session

• Tim’s Minimum Rate: $185 per session

The "Usual and Customary" Disclaimer: When we submit claims, we use timed CPT codes tied to "Usual and Customary" rates (e.g., $800 for an evaluation). These figures are set by insurance standards for our geographic area to allow for a full hour of one-on-one care. You are not responsible for the $800 balance. Your responsibility is always capped at your therapist's minimum rate as described above.

Detailed Coding Breakdown

To help you understand your Explanation of Benefits (EOB), here is how we typically bill for our 60-minute one-on-one sessions:

Initial Evaluation (First Visit)

Total Billed: $800

• 97161 (PT Eval): Comprehensive assessment of strength, movement, and tissue integrity to diagnose your injury ($300).

• 97140 (Manual Therapy): 2 units of hands-on treatment, such as joint or soft tissue mobilization ($250).

• 97110 (Therapeutic Exercise): 1 unit of exercises that build general strength and mobility ($125).

• 97112 (Neuromuscular Re-ed): 1 unit of exercises to improve balance, stability, and muscle firing efficiency ($125).

Follow-Up Sessions

Total Billed: $500

• 97140 (Manual Therapy): 2 units of hands-on treatment ($250).

• 97110 (Therapeutic Exercise): 1 unit of strength and mobility work ($125).

• 97112 (Neuromuscular Re-ed): 1 unit of coordination and efficiency training ($125).

Cancellation & No-Show Policy

To be courteous to other patients and therapists, we require at least 24 hours’ notice for cancellations:

• More than 24 hours: No charge.

• Within 24 hours: $60 fee.

• Within 12 hours or No-Show: Full appointment fee ($150).