Self-pay
Ask the practice for the current visit rate and payment expectations before scheduling. Self-pay amounts should be confirmed directly rather than inferred from an insurance claim.
Clear information before care
BCBS PPO, insurance and pelvic floor therapy costs
The Healthy Pelvis is in-network with Blue Cross Blue Shield (BCBS) PPO and out-of-network with other insurance plans, except Medicare. If you have an out-of-network plan, Melissa can prepare a superbill for you to submit to your insurance. We are happy to help you understand your options before you begin care.
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Private one-on-one care • In-network with BCBS PPO • Internal assessment is always optional
Editorial update by The Healthy Pelvis • Updated
Clear information before you begin care
20+ years of physical therapy experiencePrivate one-on-one visitsIn-network with BCBS PPOElmhurst and nearby western suburbs
In-network care
The Healthy Pelvis is in-network with BCBS PPO
Being in-network means The Healthy Pelvis has a participating-provider relationship for eligible BCBS PPO plans and submits covered services according to plan requirements. It does not mean every visit is free or that every BCBS product uses the same network.
Your responsibility may include a deductible, copay, coinsurance or a noncovered amount. Benefits can also include visit limits, prior-authorization requirements or rules about referrals. Verification helps estimate what to expect, but BCBS makes the final decision when a claim is processed.
- Deductible
- The amount you may need to pay for covered services before the plan begins sharing costs. Individual and family deductibles can interact differently by plan.
- Copay
- A fixed dollar amount some plans assign to an outpatient therapy visit. Not every PPO plan uses a copay.
- Coinsurance
- The percentage of the plan's allowed amount that may remain your responsibility after applicable deductible rules are met.
- Out-of-pocket maximum
- A plan-defined limit on certain covered in-network costs during a benefit period. Not every charge counts toward it.
From scheduling to claim
How the billing process generally works
- 1
Share your current insurance information
Provide clear images of the front and back of the card, the subscriber's information and any plan changes before the first visit.
- 2
Benefits are checked
The practice reviews available eligibility information, including network status and reported cost-sharing details when accessible.
- 3
You receive skilled care
Treatment is based on clinical need and your goals. Covered services are documented and billed with the appropriate procedure and diagnosis information.
- 4
A claim is processed
BCBS applies the plan's allowed amount, deductible, copay, coinsurance and coverage rules, then issues an explanation of benefits.
- 5
Your balance is reconciled
Any estimate is adjusted to match the insurer's final processing. The explanation of benefits is not a separate bill, but it helps explain the calculation.
Options beyond BCBS PPO
Self-pay, other insurance and superbills
You do not need a BCBS PPO plan to explore care. The Healthy Pelvis is out-of-network with other insurance plans, except Medicare. Melissa can prepare a superbill for you to submit to your insurer for possible out-of-network reimbursement. Coverage and reimbursement depend on your individual plan.
Superbill
Melissa can prepare a superbill—an itemized document with provider, diagnosis and procedure information—for you to submit to your insurance. Your plan determines any out-of-network reimbursement.
HSA or FSA
Physical therapy expenses are often eligible, but account administrators set documentation rules. Keep receipts and confirm eligibility with your plan administrator or tax adviser.
Secondary insurance
Tell the practice about secondary coverage before treatment. Coordination-of-benefits rules determine which plan processes the claim first.
Coverage changes
Report a new employer plan, COBRA election, new member ID or network change promptly. Even when coverage continues, billing details can change.
Good-faith estimates
Uninsured or self-pay patients may have rights to a good-faith estimate under federal rules. Ask what applies to your planned course of care.
Call your plan with confidence
Questions to ask your insurance company
- Is The Healthy Pelvis and Melissa Scholl, PT, DPT in-network for my exact plan?
- What is my outpatient physical therapy deductible, and how much has been met?
- Do I have a copay or coinsurance for outpatient physical therapy?
- Is a referral, prior authorization or plan of care signature required?
- Is there a visit limit, and is it shared with occupational or speech therapy?
- Does my plan offer out-of-network reimbursement if I receive a superbill?
- What reference number can I keep for this benefits call?
Answers before you begin
Frequently asked questions
Can I receive care if I do not have BCBS PPO?
Yes. The Healthy Pelvis is in-network with BCBS PPO and out-of-network with other insurance plans, except Medicare. Melissa can prepare a superbill for you to submit to your insurer for possible reimbursement. Contact us to discuss your options; reimbursement depends on your plan.
If I met my individual deductible but not my family deductible, will I owe for visits?
It depends on whether the plan uses an embedded individual deductible or an aggregate family deductible and on any remaining coinsurance. The explanation of benefits and plan documents control, so the practice should verify rather than assume.
Does being in-network mean my visit is fully covered?
No. In-network status affects the contracted allowed amount and plan rules, but you may still owe a deductible, copay, coinsurance or noncovered amount.
Do I need to wait for insurance approval before scheduling?
Not always. Some plans allow care without prior authorization, while others have referral or authorization rules. Confirm plan requirements before relying on coverage.
Can I use HSA or FSA funds?
Pelvic floor physical therapy is commonly treated as an eligible medical expense, but your account administrator and tax rules determine eligibility. Keep receipts and ask the administrator when uncertain.
What is a superbill?
A superbill is an itemized statement containing provider, diagnosis and procedure information. It allows you to request possible out-of-network reimbursement directly from your insurer; it does not guarantee reimbursement.
What happens if my insurer processes a claim differently than expected?
Review the explanation of benefits, confirm that the plan had the correct coverage and contact the practice with the claim details. An estimate can be revised after final insurer processing.
Take the next step
Not sure which type of pelvic floor care fits?
A free 15-minute phone consultation is a simple, private way to ask questions and decide whether an evaluation makes sense.