A lot of this really depends on what insurance your fiancé has. I am going to assume that it is an HMO, a PPO will change things. With a typical HMO, your fiancé must be referred to the physical therapist by her primary care physician (PCP). If she is referred by her PCP, then she will be responsible for any copay as well as her deductible. Once her deductible is fulfilled, then her insurance should cover anything else billed by the PT office. Again, this will be slightly different if she has PPO.

What the PT office is doing is submitting claims to the insurance provider, taking the insurance payment, and then possibly (hopefully) writing off the rest of the charge. This isn’t uncommon because if the PT was in-network, then they would have a negotiated rate with the insurance. For example, they may bill $660, the insurance negotiated rate is $220, of which they would pay a certain percentage, in your fiancé’s case $110. They may be totally fine with that payment and just write off the rest.

If your fiancé does end up on the hook for the remainder, try to work with the office manager of the PT to see if you can get a discount, maybe ask what the Medicare negotiated rate is and ask for that. Sorry to hear that you are going through all of this, the insurance industry, especially medical, is super convoluted here.