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Insurance claims are not filed on your behalf because the Business Model necessary for an insurance-based PT practice does not support the  Clinical Treatment Model that I use.  Therapists in clinics that bill insurance have to see 2 or more patients per hour and use Aides and have more non clinical staff.  

 

I prefer to see my patients one-on-one for up to an hour, provide superior direct care getting them out of pain, sooner, with less treatments, using the treatments that  research supports, that resolve the problem more effectively, and get people back to what they want to be doing. This is one reason the results are so much faster than average.  

 

Can I bill my insurance for reimbursement of my out-of-pocket expenses?

 

This depends on the insurance you have, but YES, most patients can get some reimbursement for their treatments. You should be able to print claim forms off your insurance company’s website, and send it in with the needed receipts and treatment codes (CPT codes and ICD 10 codes- also known as the Superbill) that will be provided to you upon request. This can also be done using an app reimbursify.com.

 

 The amount of reimbursement is completely dependent on your insurance plan. If you call your insurance company to inquire, you should ask about reimbursement for “out-of-network Physical Therapy” expenses.

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*Please read below on how the changes in many health insurance plans and deductibles have actually made it Cheaper to Not use your insurance for some services (like PT) if you have high PT copays or a high deductible. 

 

 

Why is insurance not billed at Physical Therapy Studio? Did you say that can actually save me money?

 

The short answer:

• In many ways, insurance companies dictate or strongly influence the treatment that patients receive at “in-network” clinics, and we refuse to allow that to be the case here.

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The longer answer:

• We are an out-of-network practice because the business model necessary for an in-network practice to survive rarely ever allows for the high-level care we insist on giving our patients.

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What the heck does that mean?

• Due to progressively worsening reimbursement rates and pressure from insurance companies, the therapists at in-network clinics have to see at least 2 patients per hour (usually many more) and they often use technicians and assistants to provide much of the actual patient care. The care often includes modalities like heat packs and ultrasound, and the majority of a patient’s time at the clinic is spent doing exercises they could do on their own time. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week. Hot packs and ultrasound were the best modalities we had 30 years ago. They feel good for a few hours!  

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We do not believe that these modalities are nearly as effective as our "hands-on treatment", and newer technologies( which many insurances do not pay for).

 

We also do not agree with having patients pay to perform exercises in the clinic that they can easily perform at home or at a gym.

 

We do agree that our clients need to know:

• What exercises are safe to be done at home to stay active and

• What specific exercises and how, ie. technique, form and dosage ( how many reps, how often ) .

 

These need to be done to rebalance muscle imbalances, restore normal biomechanics and progression to prepare to return to sport, or better sleep, or just doing what you want to do, without living in dread of pain returning.

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We do believe that vulnerable tissues need to be protected while we strengthen around them. 

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We do believe the root cause needs to addressed and imbalances corrected.

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We do believe the body is innately intelligent and will heal,if it has the resources it will heal

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We provide:

• The right "hands on" care to calm stressed tissues,

• Resources to reduce inflammation, to  repair and renew and the components or basic building blocks in the right time frames to give the body the best opportunity to heal,  and return to optimal health

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To recap:

• Exercise, strengthening, stretches and self management are necessary to complement what gets done in the clinic to  to progress your healing journey, for repair and renewal of tissues as well as return  to optimal health.

• Must be correct dosage(what, when, how , how much, how often and when to progress or stop a particular exercise)

• Must address inflammation first- when inflammation comes down , pain follows!

• Nervous system controls everything. If nerves are inflamed, muscles will tense or spasm to protect further movement and further damage to nerve, or harm to body. Again, address inflammation first- when inflammation comes down , pain follows!

• Muscle spasm is not the problem! It is the protection.

• Pain is not the problem! It is the message.

• Pain inhibits strength.  Strength may not be the problem!

• When pain is down, and brain feels safe! - it is safe to exercise!

• Pain is not the source! Inflammation is

• Inflammation is not the root cause!  Let's find out what is!

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* Most bodies take 6-8 weeks to heal. If it is a tweaked ankle and you come in immediately , the healing time is shorter!. If you have had chronic pain for years the healing will take longer and may need to add a couple extra weeks for each year you have had the pain. 

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* We see most of our clients initially 2x week for the first and perhaps second week and then 1x week for the course of treatment.

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Clinic visits:

• All of our patients in the clinic receive one-on-one care and  "hands-on" treatment from a Holistic  Physical Therapist in every session. Most sessions are a full hour unless the patient chooses 30 minute sessions. With this long-session, one-on-one treatment approach, the plan of care for the vast majority of our patients only involves one appointment per week.

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Virtual Physical Therapy (on-line):

• You will receive "one-on-one" care and an exercise and self management based treatment from a Holistic  Physical Therapist in every session. Most sessions are  30 minute sessions.  

•  The plan of care usually is 1-2 visits per week initially, then usually only involves one appointment per week.

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Physical Therapy Studio is not for everybody! It is for highly motivated people who value their health!

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When you consider the time savings of fewer trips to the clinic and the value of resolving your pain so much faster than average, the out-of-pocket expense at Physical Therapy Studio  is a huge cost saver. 

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On top of that, the out-of-pocket expense for our treatment sessions is sometimes less than a patient would pay at a clinic that accepts and bills their insurance.

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How is that possible?!

• As deductibles and PT copays have skyrocketed in recent years, many of our patients who have high PT copays or have not met their deductible pay less out of pocket for our treatments than they would if they went to a clinic that “takes their insurance.” 

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So before deciding on where to get PT based solely on which clinics “take your insurance,” make sure you know how much you’ll be paying at your in-network options versus an out-of-network clinic like ours …

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These days, some insurance plans provide zero coverage for PT visits or require copays of over $50/visit. And if you have a deductible to meet, you’ll likely end up paying the full bill for your PT sessions until you meet the deductible (and these bills are often $300+ per session). However, you usually won’t start receiving those $300+ bills until after you’ve been getting care for 6-8 weeks and have racked up an enormous total balance (again, often being asked to attend PT 2-3 times per week).

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And guess what else… just because you’re paying $300+ per session at a clinic that is in-network with your insurance, does not mean that your insurance is applying that full amount towards your deductible! They often only apply the amount that they have agreed is reasonable for your PT sessions which is, of course, far less than the amount the PT clinic actually charges.

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Most people are quite unaware of the games their insurance companies play in order to pay out as little as possible and maximize their profits.

 

So as you weigh your PT options, it’s very important to:

1. Inquire with your insurance company about what percentage of the total PT bill you will be required to pay at an in-network clinic (especially if you still have a deductible to meet). If you will be paying 100% of the bill till you’ve met your deductible, ask the prospective PT clinic the amount of the average bill sent to an insurance company (the PT clinic’s amount on the bill … NOT what the insurance company has agreed they will pay the clinic). In most cases, you will ultimately be paying the full bill until your deductible is met.

2. If you have met your deductible, ask how much your copays will be? Ask how many times per week the average patient is asked to come in for treatment.

3. Consider the quality of care you’ll be receiving at your various options, and how much value you place on receiving higher-quality, one-on-one care from an experienced Holistic Physical Therapist rather than a PT Assistant (PTA) or an unskilled “Tech.”

4. Consider how often you’ll be missing work and/or time with family to attend your PT sessions. Again, you can ask any prospective clinic how many times per week their average patient is asked to come in for treatment.

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Ask the above questions, do the math, and you may be quite surprised at what you find!

 

*One other thing to consider is whether or not you have just one deductible or if you have both an in-network deductible and an out-of-network deductible. If you have two deductibles, then claims from an out-of-network clinic like ours will not apply to your in-network deductible.

 

With all the above information, you can now get a real sense of what your true costs will be, what level of care you’ll be getting, and then make the best decision on where to receive your physical therapy treatment.

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Can I bill my insurance for reimbursement of my out-of-pocket expenses?

 

This depends on the insurance you have, but YES, most NON-Medicare patients can send “self-claims” to their insurance company for their treatments at our clinic. You should be able to print claim forms off your insurance company’s website, and send it in with the needed receipts and treatment codes that will be provided upon request at our clinic.

The amount of reimbursement or application towards your deductible is completely dependent on your insurance plan. If you call your insurance company to inquire about what you can expect to receive, you should ask about reimbursement for “out-of-network Physical Therapy” expenses sent in via self-claims.

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Medicare Beneficiaries: The US government has some interesting laws that control where Medicare beneficiaries can spend their healthcare dollar and persuade healthcare providers to enroll in their system. Because we are not Participating Medicare Providers, we can only accept Medicare beneficiaries as patients when the patient does not want Medicare billed for any PT services. This request to not involve Medicare in payment must be made up front by the patient and be made of the patient’s own free will.

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In other words, if you’re a Medicare beneficiary and are adamant about seeing us for your care even though we are not participating Medicare providers, we can help … However, the only way we can provide you with PT services is when you truly don’t want Medicare involved and you ask up front that Medicare not be billed or involved in your physical therapy care.

If you do want to use your Medicare benefits for physical therapy, we cannot provide you with treatment at our clinic but we can help you find a good Medicare provider in your area.