We don’t play the insurance game
And that’s exactly why. It’s because it’s a game. I am not okay with your insurance company deciding what kind of care I can provide to you. They’re not paid to care about you or your goals. Healthcare is broken and it can be a much better investment of your time and money to deal with a real human, especially for something as intimate and important as your pelvic health.
Occupational therapy is direct access in California and you do not need a referral to receive services. If you are using out-of-network benefits, it’s possible that your insurance company will ask for a referral from a physician.
Soft Power does not have active contracts with any insurance companies, but I can provide you with a super bill if you have out-of-network coverage. Credit card and HSA or FSA payments are also accepted at the time of service. I do not directly communicate with insurance companies, so it is your responsibility to understand your benefits and submit the paperwork they require for reimbursement. Check out Reimbursify to help navigate out-of-network coverage for occupational therapy.
All sessions are provided by a licensed occupational therapist and may be eligible for HSA/FSA payment or out-of-network insurance reimbursement.
How Insurance & HSA/FSA Works:
Pay at the time of service — you can use credit card, or HSA/FSA.
Receive a superbill — includes CPT codes, diagnosis codes, and session details.
Submit to your insurance (usually an online portal, but maybe email or snail mail) to request reimbursement.
Deductible & Reimbursement:
The full billed amount counts toward your insurance deductible, even if your insurer reimburses part of it.
Most out-of-network plans reimburse 50–80% of the billed amount.
HSA/FSA payments are tax-advantaged, but do not automatically count toward your deductible. You must submit the superbill for that.
Example:
Follow-up session billed $175
If your insurance reimburses 70%, you would get $122.50 back
Your out-of-pocket cost is $52.50
Full $175 can be applied to your deductible
Why is out-of-network pelvic floor therapy better?
Pelvic floor therapy addresses a wide variety of symptoms that often aren't prioritized by insurance companies. Not accepting insurance means I can offer personalized, hour long sessions that focus entirely on you, your goals, and your symptoms. This allows me to treat all aspects of your health without being limited to just one body part or specific diagnosis due to insurance restrictions. In insurance-based practices, therapists often need to see multiple patients at once and you might be passed around between different therapists, assistants, and aids who don’t know you or your full story. It’s not their fault! It’s because insurance reimbursement rates are low and the system is failing everyone.
In this cash-based model, we can work together to create a care plan that fits your schedule and budget. I respect your time and will never recommend more appointments than necessary to help you achieve your goals. With price transparency, you’ll never get an unexpected bill due to insurance denials that can be very common in pelvic health. While paying out-of-pocket may seem like a bigger up-front investment, we’ve found that a lot of folks might actually pay less overall to work with cash-based providers. High co-pays, high deductibles, and treatment plans that expect therapy 2-3 times a week can make insurance-based services the less affordable option. With my expertise, your sessions will be efficient and highly-focused, so you’ll likely need fewer visits overall.
How to find out if you have out-of-network benefits
Your insurance company’s phone number should be on your insurance card. You can call that number and speak to a representative to ask if you have coverage for out-of-network occupational therapy. You can ask about your deductible, co-insurance, and maximum benefit. You can also ask what percentage of the total they will reimburse for occupational therapy services. This is usually 50-80%. You can also ask about in-network waivers if this type of specialized care is not available in-network or within a reasonable time frame or distance. There can be long waitlists for specialty providers who are contracted with insurance companies.
If they ask for CPT codes, you can say:
97166
97110
97112
97140
97530
Disclaimer:
Insurance coverage, reimbursement rates, and deductible application vary by individual plan. The information provided here is for general guidance. Clients are responsible for confirming their out-of-network benefits and submitting superbills according to their insurance requirements. Use of HSA/FSA funds is subject to your plan’s rules.
Reach out if you have questions and we will do our best to help! You can also use Reimbursify as a patient to help understand your benefits and manage out-of-network insurance claims so your reimbursement process is less of a headache.
I legally cannot see Medicare or Medicaid/Medi-cal patients for pelvic floor therapy due to limitations built into the system.
