INSURANCE COVERAGE & PAYMENT OPTIONS

Coverage & Payment Options at Repsher Physical Therapy

We offer several options to make your care accessible and convenient. Here’s what you can expect:

  • If you have a provider’s prescription, you can use the following to pay for your visits:

    • Insurance Coverage

      • We accept most major health plans, including Medicare, Workers’ Compensation, No-Fault (auto accidents), and many commercial/private plans (e.g., CDPHP, MVP, Aetna, United Healthcare).

      • Plans may vary in referral, copay, and visit limit requirements.

      • Many insurers require a prescription for coverage—even if you start therapy through Direct Access.

      • Our front desk will verify your benefits and notify you if a prescription is needed before your first appointment.

    • Self-Pay Option

      • No insurance or prefer to pay out of pocket?

      • Affordable self-pay rates available for evaluations and follow-up visits.

      • Great for high-deductible plans or those without coverage; no visit limitations.

  • If you don’t have a prescription but still want to attend therapy, you might be eligible for:

    • Direct Access

      • Thanks to New York State laws, you can begin physical therapy without a physician referral for up to 10 visits or 30 days.

      • Speeds recovery and reduces delays in care.

      • Some insurance plans still require a prescription for coverage—we’ll confirm your benefits before you begin.

  • Have questions about coverage?

    • Call us! We will:

      • Review your specific benefits

      • Help with pre-authorizations if needed

      • Ensure you understand your coverage and any prescription requirements before starting

Your Coverage Options

Commercial Insurance

At Repsher Physical Therapy, we are dedicated to delivering high-quality care with a focus on accessibility and convenience. To support this mission, we accept a broad range of commercial insurance plans to meet the diverse needs of our patients.

We proudly partner with many major national carriers as well as regional and specialized insurance providers, including:

  • CDPHP

  • Medicare

  • New York State Empire Plan (NYSHIP)

  • Highmark Blue Shield

  • Anthem Blue Cross & Out of Area Blue Cross (formerly Empire Blue Cross)

  • MVP

  • Aetna

  • Fidelis

If your plan is not listed, we encourage you to call our office at 518-489-2524 to confirm coverage, as we may accept additional insurance plans.

Our experienced administrative team is well-versed in the complexities of insurance policies and is here to help you navigate your benefits. We recommend contacting us prior to your appointment to verify your coverage and determine whether services may be subject to a deductible, coinsurance, or other out-of-pocket costs.

Our goal is to make your physical therapy experience as smooth and stress-free as possible. We will work directly with your insurance provider to coordinate coverage—so you can focus fully on your recovery and well-being.

Cash-Based (Private Pay) Physical Therapy

At Repsher Physical Therapy, we proudly offer a cash-based physical therapy model—an approach in which patients pay directly for services rather than relying solely on insurance reimbursement. This model allows us to prioritize patient care, simplify processes, and ensure more personalized, results-driven treatment.

Why We Offer Cash-Based Physical Therapy

  • Enhanced Patient-Therapist Relationship
    Removing insurance company restrictions allows our therapists to focus solely on your progress—without arbitrary limitations or unnecessary red tape. You and your therapist work together to achieve the best outcomes possible.

  • Individualized, Unrestricted Care
    Treatment decisions are based entirely on your clinical needs—not what your insurance plan will authorize. This freedom allows us to design and deliver the most effective plan of care for your condition.

  • Simplified Billing Process
    With no third-party involvement, billing becomes straightforward and stress-free. Our team spends less time on paperwork and more time helping you reach your goals.

  • Transparent Pricing
    You’ll always know the cost of your treatment upfront, allowing for better budgeting and fewer surprises.

  • Lower Total Costs
    Without inflated charges or insurance markups, the overall cost of care is often lower. Research shows that cash-based physical therapy often leads to faster results in fewer visits—saving both time and money.

Is Cash-Based Physical Therapy Right for You?

While many patients appreciate the flexibility and value of our cash-based services, others may prefer to use their insurance benefits—and we support that too. Repsher Physical Therapy is proud to offer both insurance-based and cash-based options, so you can choose what works best for your health and finances.

Direct Access in New York State

Under Chapter 298 of the Laws of 2006, New York authorizes licensed physical therapists with at least three years (4,320 hours over 36 months) of practical experience to evaluate and treat patients without a physician, dentist, podiatrist, or nurse practitioner referral starting November 23, 2006.

Eligibility Requirements at Repsher PT

At Repsher Physical Therapy:

  • Patients may receive treatment for up to 10 visits or 30 calendar days, whichever occurs first, without a referral.

  • The treating PT must be 21 years or older, licensed in NY state, and have ≥ 3 years of experience.

Required “Notice of Advice”

Before starting treatment under direct access, Repsher PT must provide and have the patient sign a written notice that:

  1. Explains treatment may not be covered by insurance without a referral, but could be if a referral were provided.

  2. Includes the patient’s name, address, signature/date, and the therapist’s name, business address, and signature/date.

  3. States the start date of treatment.
    A copy is kept in the patient record to ensure compliance.

Timeline & Scope

  • The initial evaluation does not count toward the 10‑visit maximum; only actual treatment visits do.

  • The 30‑day count starts from the first treatment date, includes weekends/holidays, and ends 30 calendar days later.

  • If the patient needs more care beyond these limits, a referral from an appropriate provider is required to continue treatment.

Insurance Considerations

  • Many commercial insurance plans in NY cover direct access PT, but some require referral for reimbursement—worker’s compensation, no‑fault auto insurance, Medicare, and certain state plans typically need a referral from intake.

  • Repsher PT will generally assist with verifying your insurance benefits before your initial visit. If your insurance plan mandates a referral, they will inform you.

Safety & Compliance at Repsher PT

  • If at any point the therapist feels that the condition is outside their scope, or progress is insufficient, they will refer you promptly to a physician or other appropriate provider.

  • All care under direct access is fully clinical and evidence‑based.

  • Documentation and compliance are maintained throughout your care.

How a Patient Can Start at Repsher PT

  1. Contact Repsher PT, mention intent to use direct access.

  2. Repsher will verify insurance coverage and determine if referral is required.

  3. On treatment day, you review and sign the Notice of Advice.

  4. Treatment begins under direct access—up to 10 sessions or 30 calendar days.

  5. If further PT is medically necessary, Repsher will coordinate referral for continued care.

Why Use Direct Access at Repsher PT?

  • Start treatment faster—no waiting for a doctor’s referral

  • Lower your out-of-pocket cost—skip extra physician copays or imaging orders

  • Empower your recovery—begin rehabilitative care sooner under an experienced PT

  • Clear clinical oversight—Repsher PT monitors your progress and ensures safe, appropriate care

    Contact us today at 518-489-2524 to learn more about our payment options or to schedule an appointment.