Patient Resources

We ask that you bring your insurance card, photo identification, and any documentation from a doctor or surgeon. We also suggest that you dress comfortably and allow access to the injured area. For example, wear shorts if you have a knee injury.

A copay, or copayment, is a fixed dollar amount for each visit predetermined by your health insurance. This is due at the time of your check-in at each appointment.

A coinsurance is a fixed percentage of the allowed amount for each appointment that you are responsible for paying. For example, if your health insurance plan has an “80-20% coinsurance”, your health insurance will pay 80% of the allowed amount of the cost of the visit, and you are responsible for paying the remaining 20%.

A deductible is the total amount you are responsible for paying before your health insurance makes payments toward any healthcare expense (not just treatment at Evolve). For example, if you have a $1,000 deductible, you are responsible to pay the entire allowed amount for each appointment until you have spent $1,000 on services subject to a deductible (of note, some healthcare services are covered without having to meet your deductible, but that is individual to each health insurance plan). In other words, you are paying the amount your health insurance company would pay if you didn’t have a deductible. Once your deductible is met, your financial responsibility will likely change. In some health insurance plans, you will be responsible for a copay, a coinsurance, or your health insurance could cover all of your future healthcare expenses until your plan year resets.

Payment is expected at the time of service. While copayments are the only fixed cost, a “cost estimate” is detailed in your specific healthcare benefit if a deductible or coinsurance applies.

The two most common types of health insurance plans are HMOs (Health Management Organization) and PPOs (Preferred Provider Organization). HMOs require you to have selected a Primary Care Physician (PCP) and have a referral from your PCP in order to see a specialist, like a physical or occupational therapist. PPOs typically do not require you to have a PCP or referral from your PCP in order to see a specialist, but may require a prescription on file.

A referral is a request submitted by your Primary Care Physician (PCP) to your health insurance for authorization of physical therapy (PT) visits. If it is approved, we receive notification directly from your health insurance company.

A claim will be established by your employer, usually with a third-party company, who will assign an adjuster to your case and manage approval and payment of your visits. Upon booking, we ask that you provide us with your WC claim number and your adjuster’s name and contact information so that we may verify your coverage prior to your appointment. Your adjuster will usually pre-approve the initial evaluation over the phone, but any further approval of visits must be requested from the Utilization Review (UR) department at the third party company managing your claim. It is very important that we receive prior authorization from UR for all visits as work-related injuries are not covered by health insurance. Evolve will process these authorization requests on your behalf and will work to advise you ahead of time if there is any potential lack of coverage.

Having physical therapy (PT) coverage simply means that you are eligible to receive therapy services. But in most cases, your coverage includes some financial responsibility. Typically with PT services, you will be responsible for a copayment, coinsurance, and/or deductible for each visit. These costs are determined by your health insurance company and depend on the plan you and/or your employer chose.

We know your time is valuable, so to prepare for your appointments, we suggest you make a list of questions for your therapist. This will help you to organize your thoughts and concerns. You can also write down a list of your symptoms and include details, such as how and when they began, what they feel like, what activities or movements make them worse…etc. Lastly, be familiar with your medical history. While some information may not seem relevant to your injury, it can still be helpful to your therapist.

We suggest that all new patients arrive at least 15 (fifteen) minutes early so that you can avoid missing any critical one-on-one time with your therapist. Though you may have filled out your health questionnaire and initial paperwork, there may still be additional paperwork to review and complete.

When you arrive at Evolve, the administrative staff will be here to greet you with all of your paperwork ready to go or review if already complete! They will sit with you to review our office and financial policies, your insurance benefits and even provide a cost estimate for your treatment. The administrative staff will also make a copy of your insurance card and any doctor orders (e.g. your prescription). They will also securely place your credit card on file and be available to answer any questions. Once everything is complete and in order, you are ready to meet with your therapist.

Your therapist will review your medical history, inquire about your current problems/complaints, and discuss your personal goals and what you hope to achieve at Evolve. Your therapist will then perform an evaluation which includes taking objective measurements and assessing things like your range of motion, strength, posture, etc. You will then receive some initial treatment of your condition to begin to restore optimal movement patterns. This could be exercises or manual treatments.

Your therapist will educate you on techniques to manage your current condition. They will also teach you exercises to do at home and send you the details via email. You will conclude your initial evaluation with an understanding of the root cause of your problem and a clear and defined plan of care to get you to your individual goals.

Finally, there will be time to ask questions or revisit any topics needing additional clarification. Your therapist will walk you out to the front desk so that you can book appointments that will facilitate your optimal recovery and ensure you have appointment dates and times that work best for your schedule.

Most health insurance companies will limit the number of physical therapy visits, the duration/time frame allowed for your care, or both. The most common plans in Wisconsin are “60 visits per calendar year”, “60 consecutive days”, or “8 visits, then authorization required”. Your plan may also have shared limitations for PT, while your health insurance company might allow “up to 60 visits”. They may only authorize/allow them in small increments (4 – 8 visits at a time). For these plans, a re-evaluation is performed by your therapist and submitted to your health insurance company.  They will either approve or deny further coverage of care.

Please bring, or wear, clothing that will allow you to move comfortably and also provide your therapist with easy access to visualize the injured area.  We recommend shorts for any back, hip, knee, ankle or foot injury; and a tank top for any neck, shoulder, elbow or wrist injury.

From young athletes hoping to recover or prevent future injuries to geriatric patients recovering from a fall or rehabilitating a new hip joint, we treat orthopedic issues for all ages and abilities! Our specialists have the resources to help you live your best life.