Business ProfileforEquilibrium Physical Therapy

Misleading with out of pocket cost. 7 months after last service they bill me at a ridiculous rate. After admitting it was their staff error they refuse to negotiate price.

EQUILIBRIUM Physical Therapy does not arbitrarily create rates to bill the patient. Amounts billed to our patients are dictated by the patient's insurance company. Per our contracts as in-network providers we are required to bill the patient what the insurance company states is the patient's responsibility. We are unable to negotiate rates with patients. That is price fixing and not legal. Mrs. Manzano is responsible for knowing what her benefits are as they are the owners of the insurance plan. Providers are not required to check this for patients; however, our office does as a courtesy. Mrs. Manzano claims she called her insurance company and was told she is not responsible to pay even if her deductible has not been met. However, that is in stark contradiction to what the definition of a deductible is and how it works. Mrs. Manzano was unable to provide a reference / case number for her call which is given when you call into the insurance company. Mrs. Manzano's dispute is with her insurance company, she unfortunately has chosen to file a slanderous claim against our clinic simply because she does not want to pay what her insurance company states we are required to bill her as patient responsibility per our contractual obligations. Simply because the patient does not WANT to pay does not mean our clinic is in the wrong. EQUILIBRIUM Physical Therapy proceeded in good faith and according to our contractual and legal obligations. This was explained to over the phone, through email, and via mailed letter as follows (w/ redactions for patient privacy): "Per [patient's insurance company] your deductible of $XXX had not been met at the time of service for the dates you were seen at our clinic. The electronic remittance advise (ERA) we received directly from [patient's insurance company] for the claims for each of the dates: [dates redacted] state the claims were approved for the allowable amount and applied to your deductible and that the balance due is the patient’s responsibility. Following [our] phone call to you [we] called [patient's insurance company] to confirm the above information. On two separate dates (12/28/2021 reference number X-XXXXXXXX, and 1/6/2022 reference number X-XXXXXXXX). On both occasions the [patient's insurance company] stated the dates of service you were seen at our clinic are subject to your yearly deductible of $XXX which had not been met at the time of service, and that you as the patient are fully responsible for your deductible and therefore the allowable amount for all services performed before that deductible has been met. Your insurance company pays XX% only after your deductible has been met. The representative further stated that [we] should explain to you as the patient that when purchased your plan, you as the member received guidelines and rules based on the plan you selected, and you were made aware of their coverage and what you are responsible for. It is not the provider’s responsibility to give you this information. It is your responsibility to know your plan benefits. It is never the providers responsibility to tell you what your plan benefits are. Our clinic checks plan benefits for our patient as courtesy. We are not required to do so. The amount we charge our patients is not arbitrary. We charge according to what your insurance company states is your patient responsibility. To resolve your dispute, you need to speak with [patient's insurance company]. The [patient's insurance company] representatives [we] spoke with advised [us] to encourage you to call them back using the following reference numbers that were previously stated above: X-XXXXXXXX and X-XXXXXXXX." EQUILIBRIUM Physical Therapy provided services to Mrs. Manzano in good faith. Our clinic gave Mrs. Manzano the information she needed to research her dispute with her insurance company but refused to proceed with the information provided to her and file a false slanderous claim against our clinic without researching the facts using specific information forwarded to her from her insurance company.