CONTACT

415.747-8189

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ADDRESS

Kathleen McDonough MA PT PMA-CPT

224 Greenfield Ave

Ste 1

San Anselmo, California 94960

 

 

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LOCATION

INSURANCE

Do you accept insurance?

As I am in solo practice, I devote most of my time and energy to helping you feel better and achieve your goals toward excellent health. I do not employ office help. Keeping my practice simple and focused on your care helps me to keep my costs reasonable, and I feel that contracting with insurance companies, including Medicare, would jeopardize the quality of the services provided.

 

I am a Blue Shield PPO In-Network provider including most Covered California Affordable Care Act plans. 

 

Do You take Anthem/Blue Cross?

I can bill Anthem/Blue Cross, and there are a few of their plans that actually pay out of network providers a decent rate. Most Anthem/Blue Cross plans however, will re-imburse you about $25/visit for an out-of-network provider.

 

I am NOT a Blue Cross In-Network provider, and here’s why:

 

Blue Cross of California charges providers upwards of $8,000 per year for the privilege of reimbursement of about 30 cents on the dollar. In order to afford this expense and poor reimbursement, “In-Network” plans typically use a managed care (high volume) model where the licensed Physical Therapist may see you for a small portion of your visit, and then a non-licensed AIDE or TECH (not a licensed Physical Therapy Assistant) supervises the remainder of your appointment. You are billed for the treatment regardless of whether or not it is performed by a fully trained, experienced and licensed therapist. This is not the type of treatment I provide or wish to provide. In my practice, I alone provide care for my clients during their entire appointment. You get my undivided attention and the benefit of my 30+ years as a Physical Therapist and Pilates instructor.

 

What does this mean to you and your recovery?

Because “In-Network” providers often use unlicensed aides and shorter visits, your recovery may take more time, more co-pays, and more visits, which equals more money out of pocket.  When you see an “Out-of-Network” therapist, who can spend more one-on-one time with you and on your evaluation and treatment plan, and who will completely customize your care to your unique needs, you get more efficient and effective treatment. Your care and recovery from injury can therefore, in most cases, be managed faster with fewer visits, and may be less expensive than going in-network and paying for more visit co-pays.

 

Can You Bill my Insurance Company?

I use a professional billing service and I will bill your insurance as a courtesy. Each insurance company may have tens or even hundreds of different plans, so I encourage patients to review their policy and coverage. 

 

For your protection, the details of your insurance plan are not always available to me, so it is a good idea to familiarize yourself with your plan- most plans have useful websites that members can access details about their deductibles, and co-pays.

 

Most plans have a deductible, which you must meet before your plan pays for services. The deductible is the amount you must pay out of pocket. Please check with your plan to determine what your deductible is, and how much of that deductible you have met to date. Deductibles must be met yearly, and not always by the calendar year.  Some plans have separate in- and out-of-network deductibles.

 

Some plans have limits as to how much physical therapy they will cover in a year. Again, please check with your insurance for your plan details; each plan is unique.

 

Do I need a physician’s prescription?  Can I receive physical therapy services without a physician's referral?

YOU DON'T NEED A REFERRAL TO SEE YOUR PHYSICAL THERAPIST

Physical therapists are experts in physical movement and performance and can improve the lives of people through instruction and education on proper body functions. They also teach people how to avoid injury by incorporating personalized, safe, healthy exercise, and activity into daily lives.
 

Consumers are not required to have a referral or diagnosis in order to receive physical therapist services in the State of California. Physical therapist services may be obtained without a physician’s referral if you are a cash paying patient, receiving treatment for up to 45 calendar days/12 visits, or receiving health and wellness services.

 

Please note: some health insurance companies require a referral in order for them to cover (pay for) your treatment. Please confirm your benefit requirements by reviewing your coverage documents or calling member services of your respective insurance company. The contact number to your insurance company is listed on the back of your health insurance identification card.

 

Do you give a discount for cash paying clients?

Yes. If you pay me with cash, credit card or check at the time of the visit, the fee for initial evaluation is $175, and follow-up visits are $140. I will give you a  receipt for the visit, which you may submit to your insurance company for your reimbursement, or to a Health Savings Account. I do not issue Superbills for cash-pay clients.