In the world of medicine, there is no topic more frustrating, aggravating, and confusing as health insurance. Every insurance company has more than one plan option and this information is rarely laid out in a way that is easy to understand. Knowing what plan you have and what is actually covered is the first step in navigating the waters of health insurance coverage. No matter where you stand on the political, cultural, or economical spectrum, dealing with and understanding health insurance is in the your best interest.
What can you do as a patient to ensure your best shot at the fullest coverage? The health insurance market seems to offer a greater variety of plans today than it has in the past. While this means a little more homework on your part, it also means that you can find a plan that suits your particular needs. The first thing you should always do is check to see if your plan covers some level of physical therapy. If your plan doesn’t cover physical therapy or if you have a large deductible, then a therapy provider who offers a reduced cash rate for services would be a smart choice for treating pain or movement dysfunction. You would also not need a referral script and can simply schedule your own appointment. This literally bypasses insurance authorizations, denials, appeals, etc. and puts you in control of your own healthcare!
Of course this approach works even if you don’t have insurance. Reduced cash rate physical therapy visits for an evaluation will undoubtedly be one of the least expensive choices you can make when it comes to receiving skilled healthcare.
If you do have usable insurance benefits, you may run into some authorization “speed bumps” in the process. Insurance companies often ask for documentation and notes from your Physician and Physical Therapist. Be sure to work with healthcare provider offices willing to help through the process of referrals, authorizations, appeals. This includes them communicating with other provider offices to make sure the right paperwork has been done and sending chart notes when needed.
If you are planning on surgery and know that you will need physical therapy, check with the potential providers to find out which coverages are accepted. This could be the difference between in-network and out-of-network coverage and result in dramatic differences in cost to you.
You pay hard-earned money for your insurance coverage. We understand the frustrations you feel when things don’t seem right. Take time to understand your policy and your coverage. As always, we encourage you to talk to us and let our billing team help out. We navigate these rough seas every day and are here to help you.
So you just received a Physical Therapy referral from your healthcare provider. There is a lot of misinformation out there on just how much you, as the patient, may dictate where and what providers you see. A prescription for Physical Therapy is just like a prescription for anti-inflammatories, you can fill it wherever you choose. Just because your doctor may have given you a referral for their “in house” Physical Therapy does not mean you MUST go there. That would be like your doctor telling you that you can only fill your prescription at a CVS pharmacy.
A lot of people also think that their insurance controls which healthcare providers they can see. If you have an insurance plan with a low deductible and the provider is in your network, then it may make sense to go to them. Ahh, but only if you are also getting the best care. If you have a high deductible, have a community health plan (bronze plan, Medicaid), or are not insured then it might still make sense to see a Physical Therapy provider who can customize your treatment to meet your needs at a reduced cash rate.
In regards to your own health and well-being, you are your own best advocate. Don’t waste your precious time at a big box P.T. clinic that uses cookie cutter treatments and you only spend 15 minutes with a licensed provider. Come see us at Advance Physical Therapy & Sports Rehabilitation where you know you’ll get the best care, the most cutting edge treatments and get back to doing what you love faster! Call or message us for more information. We want to help you advance beyond your expectations!
Physical Therapy is often only considered after an orthopedic surgery. However, there is mounting evidence pointing to the benefit of pre-operative Physical Therapy. In the case of an impending total knee replacement, recent studies have shown as little as 1 or 2 visits decrease post-operative care by 29%, or a cost savings to the patient of more than $1000.00 per individual. Preparing the area around the damaged tissue prior to surgical intervention leads to faster recover times, better muscle recruitment, less pain, fewer visits, and a faster return to your life. Pre-operative therapy allows us to better understand the movement patterns or injuries which produced the need for surgery in the first place.
Some orthopedic surgeries that may benefit from pre-operative Physical Therapy include total knee arthroplasty/replacement, total hip arthroplasty/replacement, anterior cruciate ligament (ACL) repair, rotator cuff repair, labral tear procedures, total shoulder arthroplasty/replacement, and any non-emergency back or neck procedures. The physiological benefits of the therapy include decreasing swelling, increasing circulation, decreasing pain, strengthening surrounding muscles, and beginning the process of tissue remodeling including neuroplasticity to improve function between the brain and the affected area.
Many times patients don’t fully understand the surgical procedure they are about to undergo. Often times visiting a surgeon is a scary proposition. You usually have to wait up to a few months and when you do have the consult, so much information is thrown at you that not all of it may stick. Patients want to know how involved the procedure will be and what to expect from the post-op recovery process. Recovering from an injury and surgery has a psychological component in addition to the obvious physical aspect. As we like to say, “there’s a brain attached to the person,” meaning, your emotional state after surgery and how you are able to process and proceed while in pain is a key to recovery that is often overlooked.
So it would be a good idea to build report with your Physical Therapist and Assistants before the surgery. If you have the opportunity to work with your providers for at least a few sessions, when you return to therapy after the procedure it will put you at ease and allow you to progress more quickly. A lot of Physical Therapy is built on trust. If you can establish trust between you and your Physical Therapist before the surgery then you should expect less stress, less pain, and a better outcome.
Physical therapy before a surgical procedure can be of great benefit to your recovery. Talk with your physician about pre-operative Physical Therapy and feel free to call or email us any questions. We are here for you, before and after your surgery. Let us help you advance beyond expectations!
Joshua C. Anderson, PTA, CKTP, CCI, Cert. ASTYM
Bradford L. Bentley, DPT, OCS, CSCS, MDT, CMP, Cert. ASTYM