Thank You for choosing Benton City Physical Therapy!
Please complete the Patient Intake Information Forms (Including your insurance information) and the Patient History form and bring them with you to your first appointment. Please arrive 10-15 minutes early for your first appointment.
*If you do not have insurance benefits please complete the Self Pay Agreement and include it with your other Intake Information and bring it with you to your first appointment also.
*If you have been involved in an automobile accident, and we are billing 3rd party you should complete the Medical Lien by taking it to your attorney. You and your attorney must sign and date the document. Please note that the document will not be accepted if it is altered. Please bring this with you, along with the other intake information to your first appointment. We will not bill for a 3rd party without the Medical Lien signed and dated.
*If you have any questions please call us at 509-588-2924
New Patient Process
Please review and fill out the new patient paperwork online before your first appointment.
Private Insurance: Coverage of physical therapy is included in most insurance policies; however, you are expected to check your specific policy for appropriate coverage since you are responsible for payment of your account. We will gladly bill your primary insurance company.
Labor and Industries: It is your responsibility to provide us with your claim information ie: claim number, date of injury, claims manager contact info, etc. It is extremely important that you follow through with your physical therapy program. Failure to comply with your program may mean a suspension of your benefits.
Medicare: Our office accepts Medicare Assignment, which means our clinic will accept the Medicare-approved charge as the full charge for covered services. Medicare will then pay 80% of the approved charge. The beneficiary or their Medicare Supplement is responsible only for the 20% Medicare does not pay plus any unmet deductible. Our clinic bills Medicare directly. You must have a referral from your doctor for physical therapy.
DSHS: Before treatment can begin we must have a current referral from your doctor and a coupon for each month you receive treatment.
ACCEPTED INSURANCES (these are the most popular insurances- please call us to confirm your insurance if you don't see it listed here!)
- Blue Cross Blue Shield
- First Choice Health Network
- Health Comp
- Uniform Medical
- United Healthcare
- Veteran's Administration
- Washington State Department of Labor and Industries
- Worker's Compensation Plans
We also bill auto claims for Personal Injury Protection claims (PIP) coverage. We do not bill 3rd party claims.
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Benton City Physical Therapy is committed to protecting the confidentiality of your medical information and is required by law to do so. The Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment of health care operations, and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.
We are required by law to:
- Make sure that health information that identifies you is kept private.
- Give you this notice of our legal duties and privacy practices with respect to health information about you.
- Follow the terms of the Notice that is currently in effect.
How we may use and disclose health information about you:
- For treatment.
- For payment.
- For health care operations.
- As required by law.
- Public Health risks.
- Health oversight activities.
- Lawsuits and disputes.
- To avert a serious threat to health and safety.
- Workers Compensation.
- Right to inspect and copy.
- Right to amend.
- Right to accounting of disclosures.
- Right to request restrictions.
- Right to request confidential communications.
- Right of a paper copy of this Notice (the entire Notices is available upon request)
- For a complete copy of the Notice of Privacy Practices, please request one from the front desk and we will provide you with a complete copy.
- If you have questions or concerns or complaints about the Notice or your medical information, please contact our office and they will further assist you.
- You will not be penalized for filing a complaint.
- We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice.
New Patient Packet
Nuevo formulario Paciente
Historia del Pacíente