~ We currently accept CDPHP, Medicare, workers compensation, auto accident insurance reimbursement. The practice is currently in process for credentialing with other insurance plans.
~ Please contact us directly for additional information regarding insurance participation and fees. Our staff is happy to verify your benefits and explain your insurance coverage before starting treatment and will work with you to conserve benefits for optimal treatment outcomes. We will facilitate your insurance claims process so that you can focus upon what is most important: your health and peace of mind. The Benefit of Out of Network Physical Therapy:
~ Out of network service provision allows therapists to not be limited by arbitrary contracted rates. ~Contracted rates and insurance contract restrictions often negatively impact quality rehabilitation care. If you have been to a physical therapy practice where multiple patients are treated simultaneously or you received limited one on one physical therapist time/expertise/attention, this more than likely was the result of insurance contract stipulations.
~ The high quality and personalized attention you receive with cash based physical therapy services usually results in a more affordable and often faster route to optimal health and wellness.
~ Longer appointment times offered via cash-based service provision allow your physical therapist to provide a more thorough whole-body screening to best identify the complicated underlying causes of your condition.
~ Cash- based service provision allows therapists to target and address multiple body impairments at the same time. Unfortunately, many insurances stipulate the following restriction: one body part per episode of physical therapy care. This is not a holistic or particularly effective approach to rehabilitation.
~ Your health is quite valuable and taking care of yourself is always a wise investment. DIRECT ACCESS: ~New York is a direct access state for physical therapy service provision, so a referral for physical therapy is not required unless specified by your insurance plan. Benefits of direct access to skilled physical therapy clinicians:
~ Direct access helps patients access physical therapy services faster which helps expedite your recovery process
~ Direct access helps save you valuable time and money often spent in the cumbersome process of obtaining an unnecessary referral.
~ Direct access helps you minimize the unfortunate impact of declining insurance reimbursement levels via provision of cash-based services focusing on preventative wellness, fitness and health promotion.
~ Medicare beneficiaries can go directly to physical therapists without a referral or visit to a physician. However, Medicare patients seeking physical therapy services must be “under the care of a physician” which requires physician certification of a plan of care (POC).
~ Physical therapists are required to develop a POC for every Medicare patient and a physician or a nonphysician practitioner (NPP) must certify the POC within 30 days of the initial physical therapy evaluation.
~ Medicare does not require patients to actually visit the certifying physician or NPP, but your certifying physician/NPP may require an in person patient visit prior to authorizing a physical therapist suggested POC.
Health Insurance Terms Illuminated
Below, you will find a list of terms that pertain to insurance coverage and payment for health services. (please insert terms from active body PT website with APTA reference
- Co-insurance: in indemnity, the monetary amount to be paid by the patient, usually expressed as a percentage of charges.
- Co-payment: in managed care, the monetary amount to be paid by the patient, usually expressed in terms of dollars.
- Consumer Driven Health Care (CDHC): refers to health plans in which employees have personal health accounts such as a health savings account, medical savings accounts or flexible spending arrangement from which they pay medical expenses directly.
- Deductible: the portion of medical costs to be paid by the patient before insurance benefits begin, usually expressed in dollars.
- Denial: refusal by insurer to reimburse services that have been rendered; can be for various reasons.
- Eligibility: the process of determining whether a patient qualifies for benefits, based on factors such as enrollment date, pre-existing conditions, valid referrals, etc.
- Exclusions: services that are not covered by a plan.
- Flexible Spending Arrangements (FSAs): an account that allows employees to use pre-tax dollars to pay for qualified medical expenses during the year. FSAs are usually funded through voluntary salary reduction agreements with an employer.
- Gatekeeper: in managed care, it refers to the provider designated as one who directs an individual patient’s care. In practical terms, it is the one who refers patients to specialists and/or sub-specialists for care.
- Health Maintenance Organization (HMO): a form of managed care in which you receive your care from participating providers.
- Health Savings Account (HSA): a savings product that serves as an alternative to traditional health insurance. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.
- Managed Care: a method of providing health care, in which the insurer and/or employer (policyholder) maintain some level of control over costs and utilization by various means. Typically refers to HMOs and PPOs.
- Member: a term used to describe a person who is enrolled in an insurance plan; the term is used most frequently in managed care.
- Open Enrollment: a set time of year when you can enroll in health insurance or change from one plan to another without benefit of a qualifying evening.
- Out-of-pocket: money the patient’s pays toward the cost of health care services.
- Payer: the party who actually makes payment for services under the insurance coverage policy. In the majority of cases, the payer is the same as the insurer. But, as in the case of very large self-insured employers, the payer is a separate entity under contract to handle the administration of the insurance policy.
- Policyholder: purchaser of an insurance policy; in group health insurance, this is usually the employer who purchases policy coverage for its employees.
- Preferred Provider Organization (PPO): a form of managed care in which the member has more flexibility in choosing physicians and other providers. The member can see both participating and non-participating providers. There is a greater out-of-pocket expense if member sees non-participating providers.
- Premium: the cost of an insurance plan shared by employer and employee.
- Provider: one who delivers health care services within the scope of a professional license.
- Reimbursement: refers to the payment by the patient (first-party) or insurer (third-party), to the health care provider, for services rendered.
Reference: www.apta.org Interested in more information about our practice and proactive health promotion? Sign up for our newsletter today!
~ Several of the integrative wellness services provided (Yoga, Reflexology Sessions) are cash based and are competitively priced.
~ Individual yoga instruction by a physical therapist is a great way to prepare yourself for an eventual yoga studio group class yoga format or to ease back into yoga after an illness or surgery. Prior to participating in individual yoga sessions at IHPT, you will have the benefit of being thoroughly screened by a physical therapist for any underlying posture and/or movement dysfunction patterns that might predispose you to injury.
~ Other benefits of yoga supervised by a rehabilitation expert include individualized specific modifications to poses that will keep you safe and progressing as well as the provision of hands on assists to effectively reorganize your myofascial system/promote healing.
~ Reflexology is a form of self care that activates your parasympathetic nervous system and boosts your immune system function. Self care is important and involves a dedicated effort to do things that are health promoting and will positively impact your physical and mental wellbeing. Self care can improve your mental health by lowering stress, lowering disease risk, and increasing your energy levels.