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Many insurance carriers employ 3rd party utilization management companies, such as Evicore, to protect their bottom line by dictating the use of your healthcare benefits. These companies are responsible for approving/denying your care based on their clinical guidelines.


At Cooperative Performance & Rehabilitation, we fight back against utilization management to make sure you are receiving the quality care you deserve and pay for.


 

If we receive denials, we will work all peer review processes with utilization management prior to getting you involved in the appeal process. If we are unable to over turn the denial via the 3rd party utilization management company, we will get you involved in the appeals process directly through your insurance carrier and provide you with a patient advocacy letter directing you to the best contacts to fight back against these practices.

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Many insurance consumers have heard the term “Surprise Billing” but what is it? Surprise billing happens when a patient receives an unexpected bill after they receive care at an out-of-network facility or by an out-of-network provider. Patients typically do not know that the provider/facility is out of network until they receive the surprise bill. This practice is called Balance Billing. 


When scheduling your initial evaluation at Cooperative Performance & Rehabilitation, our administrative team will ask you for your current insurance information. If you are insured under a plan that we are not contracted with, we will inform you and check both your in and out-of-network benefits. 


If your plan has out-of-network benefits, we will review these with you and explain your expected cost per visit. If you do not have out-of-network benefits, we will provide you with our set cash pay rates. 


While we do verify your benefits prior to treatment, we always encourage patients to confirm your benefit coverage with your insurance as well. 

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To our patients,


In 2024 we have had some changes to our insurance contracting and want to ensure our dedicated clients & community receive the correct information.


As of March 10th, 2024, we are no longer contracted with Optum which includes United Healthcare commercial plans, AARP Medicare Replacement plans, and UMR.

This does not affect you if you have an AARP Supplemental plan as your secondary insurance.


We are still contracted with the following:


Medicare

Providence (Commercial & Medicare Advantage)

Pacific Source (Commercial, Medicare Advantage, & Medicaid)

Regence BCBS (Commercial, Federal, & Medicare Advantage)

MODA (Commercial & Medicare Advantage)

Cigna


If you have any questions, please feel free to reach out to our administrative team at (541)653-9696

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