Insurance & pricing
Real insurance. Real prices. No surprises.
We're contracted with major Hawaii and national plans. We tell you what you'll pay before your first visit. Nora and Max handle the rest.
Virtual PT Hawaii — powered by KinematiX™
Currently in-network with
Contracted with major Hawaii & federal payers — and growing.
Insurance is real. Authorizations, multiple plans, coinsurance, prior auth requirements — it's a maze. That's exactly why our agents are here from the first text to the final invoice. From intake to insurance verification, from prior authorization paperwork to claim submission, we got you. You don't navigate it alone.
Brian Jones, DPT is contracted with the following payers under PTX, LLC. Credentialing is being migrated to PTX, LLC dba Virtual PT Hawaii pending Hawaii BREG approval. None of this affects your visit or coverage.
Contracted payers
- Aetna
- AlohaCare (Medicaid — Med-QUEST)
- Cigna
- Hawaii Medicaid (HOKU/Med-QUEST)
- HMAA (Hawaii Mainland Administrators)
- HMSA (Hawaii Medical Service Association)
- Humana
- Medicare (via Noridian)
- MVA / No-Fault Hawaii is a no-fault state. If you've been in a motor vehicle accident, your auto insurance will typically cover your physical therapy treatment regardless of who was at fault.
- Ohana Health Plan (Medicaid — Med-QUEST)
- TRICARE West
- UHA (University Health Alliance)
- UnitedHealthcare (commercial plans)
- VA (Veterans Affairs)
- Work Comp
In-network with UnitedHealthcare (commercial plans). Medicare Advantage not accepted at this time.
What you'll pay
Your benefits, explained before your first visit.
Insurance is complicated by design. We're not. Before your first visit, Nora pulls your benefits and walks you through three numbers that determine what you pay:
Your copay — a fixed dollar amount per visit. Common range: $20–$50, depending on your plan. For some plans you pay the copay every visit; for others the copay applies only after you meet your deductible.
Your deductible — what you pay out-of-pocket before insurance kicks in. If you've already met it for the year, your insurance starts covering visits at the contracted rate immediately. Most patients hit their deductible faster than they expect because Physical Therapy visits accumulate.
Your coinsurance — the percentage of the contracted rate you pay after your deductible is met. Common: 10%–30%, depending on plan tier.
We tell you all three numbers — and what they translate to in actual dollars per visit — before you commit. No surprise bills. No drama.
More than one plan? Many patients have primary, secondary, and sometimes tertiary coverage. Often what one plan doesn't cover, another does. You don't need to sort this out alone — use the Verify Insurance form below or talk to Kai, and our team handles the coordination across plans.
Prior authorization
Some plans need approval before they pay.
Some insurance plans in Hawaii require prior authorization before Physical Therapy visits are covered. The exact requirements depend on your plan. Sometimes we need to do an evaluation first and then submit the authorization request to your insurance.
It's worth checking with your insurance directly, but you won't be doing this alone — Kai handles the verification, and our team walks you through whatever your plan requires before your first treatment visit.
If we're not in-network
Cash-pay is straightforward and affordable.
If we're not contracted with your plan — or if you prefer to skip insurance entirely — we offer transparent cash-pay rates. One rate per visit type. No hidden fees. No "facility charges." No coordination with your plan.
Many out-of-network patients can submit our visit receipts to their insurance for partial reimbursement under their out-of-network benefits. We provide the documentation; you submit the claim. We don't promise a specific reimbursement amount because that depends on your plan's out-of-network policy.
Call (808) 726-5434 for current cash-pay rates.
Common questions
FAQ
Do I need a referral from my doctor?
In Hawaii, most insurance plans allow direct access to Physical Therapy without a referral. Some plans still require one. We verify this when we check your benefits — if a referral is needed, we'll let you know before scheduling.
How many visits will my insurance cover?
Most plans cover 20–60 Physical Therapy visits per calendar year. Some have visit caps; some only require medical necessity. We pull this number when we verify your benefits and tell you exactly how many visits you have available.
Can I use HSA or FSA funds?
Yes. Both insurance copays and cash-pay visits are qualified medical expenses. Pay by HSA/FSA card at checkout or submit our receipts to your plan administrator.
Is telehealth Physical Therapy actually covered?
Yes — for all 10 of the payers we contract with. Telehealth coverage parity for Physical Therapy is established under each plan's policy. We bill the same CPT codes whether the visit is in-clinic or by video, with the appropriate telehealth modifier.
What if I have two insurance plans?
We can coordinate primary and secondary coverage. Tell Nora when you call. She'll verify both plans and explain how they stack on your visits.
My plan isn't on your list. What now?
Call (808) 726-5434 anyway. We can sometimes in-network with smaller or regional plans through our clearinghouse, and even when we can't, we can usually find a path — out-of-network reimbursement, cash-pay, or a referral to a colleague who is in-network with your plan.
Verify your insurance in five minutes.
Submit the form and Nora will reply within 24 hours with your specific copay, deductible, and visit coverage. Or call (808) 726-5434 for an answer the same day.
Coming soon: real-time benefit verification via Stedi + Availity.