Financial Policies
(Effective May 13, 2024)
We are pleased you have chosen Origin Physical Therapy (FL), PLLC, Origin Physical Therapy (CA), Inc., Clampett Physical Therapy (NY), PLLC, Sullivan Physical Therapy, LLC, Origin Physical Therapy (NJ), LLC, Fiat Physical Therapy, LLC, To The Core Physical Therapy & Conditioning, LLC, The Rosipal Institute for Pelvic Therapy Solutions, PLLC and / or The Origin Way, Inc. (individually or collectively referred to herein as "Origin") for your needs.
We bill your personal insurance carrier solely as a courtesy to you. We require that you pay the estimated amount of what you owe (“Patient Responsibility”) at every appointment. It is not a guarantee of the amount you owe, it is only an estimate. Furthermore, if your insurance coverage includes virtual visits coverage, we endeavor to bill virtual visits at the same rate as in-person visit; however, we cannot guarantee it. You are responsible for your bill, so if you would like to be certain of your coverage and patient responsibility, we encourage you to verify with your insurance company prior to your appointments.
In the event that your insurance company requests a refund of payments made to us, you may be responsible for any amounts refunded to your insurance company. If any payment is made directly to you by the insurance company for Services billed by us, you recognize an obligation to promptly remit the payment(s) to us. If formal collections procedures become necessary, you may be responsible for additional costs incurred.
We will review your estimated insurance benefits with you at the time of your visit. Your benefits are quoted to us by your insurance carrier, and we assume no liability for any errors made by your insurance carrier in this estimate. We will attempt to obtain authorization for additional appointments necessary once insurance coverage for the initial appointments ceases (including steps necessary to appeal a denial); however, this does not guarantee that your insurance will accept the request to authorize additional appointments. You are also responsible for keeping track of appointments covered by your insurance policy. You will be responsible for any visits beyond the visits authorized by your insurance carrier.
Balance Due / Self-pay / Cash Rates
You may be considered a self-pay patient and responsible to pay our direct to patient rates, and your balance owed may be due in full, if your:
- Insurance claims are denied for any reason
- Insurance coverage is inactive
- Insurance company doesn’t process your payment within 60 days
- Insurance company does not authorize visits
- Insurance company does not verify your eligibility
- Treatment exceeds the coverage of your insurance policy
- Insurance does not cover our Services
- Insurance is out of network
- Prescription (Rx), referral or Plan of Care is not provided in timely manner
- Insurance will not cover multiple appointments in one day.
Network Status
Receiving care from providers outside of your insurance plan provider network usually may result in higher out-of-pocket costs for you. Origin encourages you to contact your insurance plan to confirm that Origin is a provider within your plan’s network before engaging with Services from a Professional.
Returned Checks
Each returned check will incur a $30 returned check fee and an alternative form of payment will be required for all subsequent payments.
Assignment of Insurance Benefits
You hereby authorize Origin to furnish information to insurance carriers concerning this treatment and assign all payment for the Services.
Workers’ Compensation Claims
If you claim Workers’ Compensation benefits and are subsequently denied such benefits, you may be held responsible for the total amount of charges for Services rendered by a Professional.
Flexible Spending Account (FSA) / Health Savings Account (HSA)
Origin accepts payments from FSA/HSAs. Payments from FSA/HSAs will be reflected as “unapplied” until the claim has been processed through insurance.
Late Cancellation & No-shows
Our goal at Origin is to provide every patient with high quality care and attention. It is important that patients try to attend their appointments to achieve their treatment goals. In order to provide this care, we will make our best efforts to accommodate each patient’s schedule and reserve appointment slots accordingly.
We understand that life happens, and you may need to cancel or reschedule your appointment. In the event that you’re unable to make your scheduled appointment, we do require notice at least 24-hours prior to your appointment. This will allow us to find a different time for you to continue your treatment while also allowing us to provide care to another patient who may be waiting to be scheduled.
The charge for no-show, cancellation, or for rescheduling an appointment, including first visit, without at least 24-hour notice (each a “Late Cancellation”) is $50 (“Cancellation Fees”). After a three (3) late cancellations and/or no-show appointments, the Late Cancellation Fee will increase to $75 for any subsequent late cancellation and/or no-show appointments. The Cancellation Fees cannot be billed to insurance and will need to be paid directly by the patient prior to receiving additional Services.
A Late Cancellation is an appointment cancellation made less than 24-hours before your appointment, appointments rescheduled less than 24-hours prior to your appointment, or if you fail to appear for your scheduled appointment, or are more than 20 minutes late to your appointment. If you show up to your appointment more than 20 minutes after it was scheduled to start, you will be subject to the Cancellation Fees.
We try to send automated email confirmations and text reminders; but it is your responsibility to track your schedule in order to cancel or reschedule in a timely manner. Missing an appointment due to a missed email or text reminder does not exempt you from Cancellation Fees.
We require all patients to have a credit card on file at their first appointment. Cancellation Fees will be automatically charged. These terms serve as notice of our Cancellation Fees.
Origin also reserves the right to update this policy periodically without notice. The most current policy will always be made available on our website, at our locations, and upon request.
Modification & Termination
You or Origin may terminate your access to the Services. Origin may also suspend or terminate your access to the Services. If you want to terminate your access to the Services, please contact Origin at info@theoriginway.com and we will complete your request.
Origin may suspend or terminate your access to the Services for any reason it deems appropriate at any time, including, but not limited to, a belief that your conduct or your use of the Service violates any of these terms or applicable laws, or is otherwise harmful to the interests of Origin or its providers. In addition, Origin also may place limits on, modify, suspend, or terminate your access to the Service generally or in response to a legal or regulatory change. If your access to the Services is terminated, Origin will have no further obligation to provide you with access to the Services, except to the extent that Origin may provide you with access to your health records, or our providers are required to provide you with continuing care.
Dispute Resolution
YOU AND ORIGIN ARE AGREEING TO GIVE UP ANY RIGHTS TO LITIGATE CLAIMS IN A COURT OR BEFORE A JURY, OR TO PARTICIPATE IN A CLASS ACTION OR REPRESENTATIVE ACTION WITH RESPECT TO A CLAIM. OTHER RIGHTS THAT YOU WOULD HAVE IF YOU WENT TO COURT MAY ALSO BE UNAVAILABLE OR MAY BE LIMITED IN ARBITRATION.
Arbitration Agreement - You and Origin agree that any and all controversies, claims and disputes arising out of or related to these Terms or the Services or any information provided through the Services, including Content, whether based in contract, tort, warranty, statute, or any other legal or equitable basis, including without limitation, any dispute or claim relating to the formation, interpretation or enforceability of any part of these Terms (including the scope and enforceability of this Arbitration Agreement) and any claim that all or any part of these Terms is void or voidable (collectively, “Claims” and individually, a “Claim”), shall be finally resolved by binding arbitration, rather than in court; except that you and we each retain the right: (i) to bring an individual action in small claims court (if the Claim in question qualifies for small claims court); and (ii) to seek injunctive or other equitable relief in court against actual or threatened infringement, misappropriation or violation of intellectual property rights. There is no judge or jury in arbitration, and court review of an arbitration award is limited. However, an arbitrator can award on an individual basis the same damages and relief as a court.
The arbitration will be administered by the American Arbitration Association (“AAA”) in accordance with the Consumer Arbitration Rules (the “AAA Rules”) then in effect, except as modified by this Section. (The AAA Rules are available at https://www.adr.org/Rules or by calling the AAA at 1-800-778-7879.) The Federal Arbitration Act will govern the interpretation and enforcement of this Section. The arbitrator will have exclusive authority to resolve any dispute relating to arbitrability and/or enforceability of this arbitration provision, including any unconscionability challenge or any other challenge that the arbitration provision or the agreement is void, voidable, or otherwise invalid. The arbitrator will be empowered to grant whatever relief would be available in court under law or in equity. Any award of the arbitrator(s) will be final and binding on each of the parties, and may be entered as a judgment in any court of competent jurisdiction. If you prevail on any claim that affords the prevailing party attorneys’ fees, the arbitrator may award reasonable fees to you under the standards for fee shifting provided by law.
You and Origin agree to an arbitration on an individual basis. In any dispute, NEITHER YOU NOR ORIGIN WILL BE ENTITLED TO JOIN OR CONSOLIDATE CLAIMS BY OR AGAINST OTHER CUSTOMERS IN COURT OR IN ARBITRATION OR OTHERWISE PARTICIPATE IN ANY CLAIM AS A CLASS REPRESENTATIVE, CLASS MEMBER OR IN A PRIVATE ATTORNEY GENERAL CAPACITY. The arbitral tribunal may not consolidate more than one person’s claims, and may not otherwise preside over any form of a representative or class proceeding. The arbitral tribunal has no power to consider the enforceability of this class arbitration waiver and any challenge to the class arbitration waiver may only be raised in a court of competent jurisdiction.
If any provision of this Section, DISPUTE RESOLUTION, is found unenforceable, the unenforceable provision will be severed and the remaining arbitration terms will be enforced.
