To book an appointment, please contact us through the contact form on this site, book a discovery call, email us at tara@performersedgewellness.com or text or call 973-298-1306.

Performers Edge Wellness is a completely out of network practice. What this means is that we do not work directly with insurance companies. We do not check your benefits or submit claims on your behalf. This does not mean that you can not use your insurance. Let me explain the what and the why behind this.

The why:

I have spent over 20 years working in in-network practices. That experience has led me to start an out of network practice for a few reasons. The first is that insurance has a lot of rules and preferences regarding your care that aren’t necessarily practical. This may include wanting to see that you are attending appointments a certain number of times per week (for example) in order for them to consider the treatment medically necessary. In a lot of cases it is difficult to meet the treatment frequency for busy moms and youth athletes. While some of the time a higher frequency of treatment may be recommended, it is not always necessary. Your therapist should be able to create and provide the treatment plan that fits your needs both from a rehab standpoint and a lifestyle standpoint.

The second reason is that due to insurance reimbursement being so low (and variations in reimbursement from payer to payer) an in-network physical therapist is typically having to see 2-3 (sometimes more) patients simultaneously per hour in their schedule. This means less time with your therapist, and it may take a bit longer for you to get better due to a slower progression if their time is limited with you.

Another reason you may want to go out of network for physical therapy is due to the nature of your goals. If you are someone with an active lifestyle looking to get back to high level athletic activities, some of your rehab may not be considered medically necessary by your insurance company. Most insurance companies only consider return to basic daily activities to be medically necessary. If you have an active lifestyle and are looking to return not only to basic activities but also hobbies, fitness and recreational activities we can address all of those goals without having to deal with insurance restrictions.

We can also work on the WHOLE individual, getting to the root cause of the issue and not limited to treating just a diagnosis.

Finally, it’s all about the experience you are looking for. In-network practices are typically busy environments with lots of patients coming and going. Smaller out of network clinics offer a more personalized experience, often with much better access to your provider between appointments and an intimate community feel.

The what:

So what exactly does this mean for you? Here are a few things to consider:

• Most people have some out of network benefits offered through their policy. The specifics of this coverage varies from plan to plan, so you would need to look into your policy to see what your coverage may be. Some people get reimbursed for the entire session, however some do not get reimbursed at all.

• You can call your insurance company and speak to a representative to find out what your out of network benefits are. We have a worksheet that can be helpful in guiding the conversation to help you understand all of the nuances of your coverage and how you can submit claims for reimbursement. Please contact us if you’d like a copy of the worksheet.

• If you have an annual deductible you may not receive reimbursement for your treatment, however the sessions may apply to your deductible.

• You are responsible for paying for each session up front. The practice is not responsible if you are not reimbursed.

• You will be provided with a superbill; an itemized receipt with all of the codes and information your insurance needs for each session. This is what you will submit to your insurance company for reimbursement.

• Submission is typically fairly simple and involves mailing the paper receipt to the insurance company or submitting them through an app. The insurance company then mails you a check for the covered portion.

• One of the best parts of this process is that there are never any surprise costs. Cost is set by the provider and discounts are typically offered for bundling of services or sessions. Payment plans are also an option.

Absolutely! This is a great use of these funds!!

No, you do not! Physical therapists in New Jersey have direct access, meaning you can come to see us without having to see a physician first. This decreases the amount of time it takes for you to access care and get on the road to healing.

Of course, if we feel that you would benefit from seeing a doctor or specialist based on your symptoms or the findings of our exam, we will refer you to an appropriate provider.

Physical therapists can not “opt out” of certain government programs/insurance plans. These include Medicare and Medicaid. These plans also stipulate that their beneficiaries can not pay cash for medically necessary services. Therefore, we do not see patients who have Medicare or Medicaid.

We can and do see patients who have Tricare. We are a Certified Tricare provider.