Out of Network Provider for all other insurances:
Being an out of Network provider allows us to personalize the one-on-one care for each patient's needs. We are extremely proud of the time and attention we can give each patient but unfortunately, Insurance time restrictions and reimbursement rates won’t allow us. Ultimately, we cannot provide a high level of care we strive for by participating with in-network plans. Our model allows us to see you longer and decrease the number of visits you'll need by more than half.
This means we do not take insurance directly and payment is due in full at the time of your visit. PivOTal Performance OT will provide you with a smart bill form that you may submit for out of network payment from your insurance. As long as your insurance plan has out of network coverage, you will be reimbursed based on your benefits. It is your responsibility to understand your benefits and coverage.
To Medicare clients:
PivOTal Performance Occupational Therapy PLLC is a participating Medicare provider. Medicare will pay 80% of Medicare-approved charges. If you have secondary insurance, the remaining 20% may be paid by your secondary insurance as it is very possible we may be out of network with them. If you do not have secondary insurance, the remaining 20% will be collected as a coinsurance. Please check your Medicare Handbook for details about capitation and run-out benefits.
We currently accept Aetna, Empire BC/BS, Empire plan, Medicare, and MVP, United-Healthcare Dual Complete, Veterans Affairs Community Care Network