FAQs

Frequently Asked Questions

As a patient of Embody Health & Performance, you may have questions regarding our services, billing, insurance, or setting up a visit with us. We have listed some common questions and answers for you that will help explain and provide additional information. If your questions go beyond what is listed below, we would love to help, please call our office directly at 952.935.4037 or email us at team@embody-hp.com.

Q: Do I need a referral to go to physical therapy?

A. No. Embody Health and Performance accepts clients without a physician referral. Minnesota is a direct access state, meaning you have the right to access physical therapy without a referral for 90 days. This means you no longer have to wait to get treated for injuries that would immediately benefit from physical therapy services.

However, Medicare and some other insurances may require a physician referral in order to cover your PT visits. You may call your insurance company’s customer service number on the back of your insurance card to verify your policy’s direct access coverage requirements.

Q: When would I utilize Embody Health & Performance's Services?

A:  Anytime you’re looking to maximize your health, life, and/or sport performance.  You don’t need to be injured or recovering from surgery in order to consider the services of a physical therapist, though Embody also specializes in rehabilitation.

Q: Should I bring my insurance card with me?

A. Yes, Merz/Embody will need the information on your insurance card to correctly file a claim with your insurance company. You will be asked to present your insurance information at your initial visit.

Q: How do I know if I am in-network with my Insurance?

A. We are contracted with most major insurance companies. Prior to scheduling, please contact your insurance company directly to inquire whether “Merz Physical Therapy” is in-network for your health plan. If it still looks like you are out of network, call us and we can help verify your coverage.

We accept most PPO insurances, including but not limited to this list:

  • Auto Insurance

  • Blue Cross Blue Shield

  • Health Partners

  • Medica

  • Medicare (Non-Assignment of Benefits)

  • Preferred One

  • Worker’s Comp

 

Q: Do I need a prior authorization?

A. The need for a prior authorization differs by insurance plan and the type of procedure or service being provided. Typically, Merz/Embody will initiate the prior authorization request from your insurance company for you.  However, it is the client’s responsibility to make sure that prior authorization is obtained before receiving certain health care procedures and/or services.

Q. There are some insurance terms that I'm not understanding. What do they mean?

A:

Deductible

A deductible is usually a fixed dollar amount that you have to pay out of your own pocket before the insurance will cover the remaining eligible expenses. Depending on the insurance plan, the deductible can range from $0 all the way up to thousands of dollars. It can also be paid per sickness/injury (per condition) or per certificate period.

Coinsurance

Coinsurance is usually a percentage, and represents the percentage cost that you will need to pay and the insurance plan will pay towards your eligible medical expenses. Some common coinsurance examples include: 80/20, 90/10 and 50/50 – so if you have 80/20 coinsurance on your insurance plan, it means that the insurance company will cover 80% of your medical cost and you are responsible for paying the other 20% yourself. A deductible is commonly use together with coinsurance. In this case you would pay the deductible amount first and after you would have the left over coinsurance amount.

Copay (Copayment)

Copays are similar to deductibles, in that it is usually a fixed amount of money you have to pay each time you need to use your insurance plan. Unlike deductibles, copays tend to be smaller dollar amounts and are applied on a per visit basis so that that you would have to pay it each visit. At Merz/Embody, your copay will be collected prior to every session.

Non-Participating Medicare Provider

Because Embody is a non-participating provider, Medicare will be sending you a check for Medicare’s portion of your physical therapy services here. Most patients endorse the received check and bring it into our clinic for us to deposit. Alternatively, you may deposit the Medicare check into your account and then make immediate payment to Merz Physical Therapy for the same amount. You will also be receiving a bill from Merz Physical Therapy for the amount that Medicare and your secondary insurance does not cover. The amount is approximately $15.00- $25.00 per date of service (which is 15% of the Medicare Allowed Amount). Our statements are mailed out monthly from WebPT, Inc.

 

Q: What if I don’t have insurance?

A. Embody Health & Performance welcomes you. We offer cash pay for anyone without insurance. This is also a great and more cost effective option for patients with high-deductible insurance plans. Payments are due before the start of every visit and we accept most major credit/debit cards, check and cash payments.

Q: How do I update my insurance information?

A. Please notify the clinic immediately of any insurance changes and present your new insurance card at your next visit. It is the patient’s responsibility to ensure insurance information on file is current. This will ensure claims are properly submitted and processed in a timely manner and to maximize your coverage.

Q: When will I receive my first statement?

A. Merz will submit a claim on your behalf to your insurance carrier via our third party billing partner, WebPT. After your insurance provider processes your claim, WebPT will mail a statement outlining any out-of-pocket costs you may have. Your statement will include any deductibles and/or coinsurance amounts you may owe. You will receive a statement approximately 60-90 days after you receive services. For specific questions about your bill, please call our Billing Company, WebPT, at 877.288.2162, and ask for Kelly.

Q: Why didn’t my insurance company cover my entire bill?

A. Out-of-pocket expenses are determined by your insurance plan during claim processing. These amounts may include co-payments, deductibles, and/or co-insurance. If you have questions or don’t understand the amounts you owe, please contact your insurance company directly as they determine patient responsibility amounts for any services provided to you based on your insurance plan contract. For specific questions about your billing statement, please call Merz/Embody at 952.935.4037.

Q: When do I become responsible for my bill?

A. You are responsible for your bill at the time you receive services from Merz/Embody. Co-payments are due at the time of service. We will work with you and your insurance company to get all eligible benefits processed in a timely manner. We will send you a statement approximately 60-90 days after you receive services for any patient responsibility amounts you may owe. If you are having trouble paying your bill, or need a payment plan, please reach out to our business office at 952.935.4037.

Q: How can I pay my bill?

A. Payments can be made by calling our office to pay over the phone or you can pay in person at any of our office locations – our front desk staff will be happy to help you. You can also mail payment with the information provided in your statement.

Q: How long is a typical visit at Merz/Embody Health and Performance?

A. The initial evaluation is typically 75 min or less (including any time to fill out intake paperwork) from the start of your scheduled appointment time. Any visits beyond that may vary depending on the needs of the patient, but typically run 45-60 min. We only bill for services rendered during the visit and thus, not every visit is the same.

Q: My insurance has strict limits on how many physical therapy visits I have per year. What options do I have when my benefits run out?

A large percentage of our practice is performed on a “cash pay” basis. Moreover, we will work with you specifically by providing a thorough “home exercise program” with appropriate “upgrades” to allow you to do much of the work on your own.

Have an additional question?