In-Home Evaluation, Treatment, and Prevention of Falls
Medicare will pay for rehabilitation services if significant functional progress is expected to be made in a reasonable period of time. Once an individual has achieved the goals that have been established, continued services can be billed privately if you wish to have a SureSteps therapist help you to maintain your activity level.
For Medicare covered services with SureSteps, Inc., Medicare pays 80% of charges. We then bill the 20% to your supplemental or secondary insurance policy, or to you privately if you do not have additional insurance. Supplemental or secondary insurance payment is subject to copays or deductibles.
In our billing experience, the following supplemental or secondary policies have not required client copays or deductibles:
Coverage among the various Blue Cross and Blue Shield plans varies depending on the plan. Medigap plans will cover the 20%. North Carolina’s BCBS Teachers’ and State Employees’ plan always requires a per visit copay.
The above list is based on our past experience but does not guarantee payment from your insurance carrier. As you understand in today’s health care and insurance markets, terms of coverage in insurance plans do change. You are advised to check with your secondary or supplemental insurance policy for more guidance on coverage.
We also bill selected Medicare Advantage programs (HMOs or PPOs). We can help you determine if your Medicare Advantage plan will cover rehabilitation services provided by SureSteps.
All Medicare and other insurance billing for services provided by SureSteps, Inc. is managed by Professional Data Management, Inc. of Goldsboro, NC:
SureSteps, Inc. is a Medicare Part B, or out-patient therapy provider. We accept Medicare assignment which means that we bill no more than what Medicare determines to be a reasonable rate for physical and occupational therapy services in North Carolina. The costs to Medicare for therapy with SureSteps, Inc. are typically considerably lower than they would be if provided through a home health agency because we are a Part B provider.