UNDERSTANDING PAYMENT FOR PHYSICAL THERAPY

Physical therapists are professional health care providers who are licensed by the state in which they practice. You can check with your state agency overseeing physical therapy licensure to make sure that your physical therapist is licensed and in good standing or with the state's physical therapy chapter. The following are common questions and answers pertaining to payment and insurance for physical therapy services.

Does insurance cover physical therapy services?

Most insurance plans, including Medicare, workers’ compensation, and private insurers, pay for physical therapy services that are medically necessary and that are provided by or under the direction and supervision of a physical therapist.  Your physical therapist or your insurance company can tell you whether your insurance covers the recommended services and how much your out of pocket costs will be if there are any.

What if your physical therapist doesn’t participate in your insurance plan?

Most insurance companies, with the exception of Medicare and many HMOs, allow members to go "out of network" for health care services.  Going out of network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. In most cases, the amount paid by the insurance company will be less, and you will be responsible for paying the difference between what the physical therapist charges and what the insurance company pays. Many patients choose to receive services out of network in order to see the physical therapist of their choice.  Your physical therapist can let you know in advance of your treatment what your out of pocket costs will be.

What if you don’t have insurance?

If you don't have health insurance that covers physical therapy services, you can still receive services from a physical therapist by paying for the services directly.   If cost is a barrier, you may want to ask your physical therapist to modify your program so that you can do more of your treatment on your own.  Ask about establishing a payment plan so that you can get the care that you need when you need it most.

Are there some services that physical therapists provide that are not covered by insurance?

Some physical therapists provide services that may not be covered by insurance plans. Examples of these services include fitness and wellness programs, sports performance enhancement, health education classes, and some prevention programs. Many individuals find these services to be of tremendous value and readily pay out of pocket for them.  Your physical therapist can let you know whether these services are covered by your insurance and can give you information about their cost in advance.

IS YOUR INSURANCE IN - NETWORK?

Rolling off that post last Thursday regarding the differences between copays, deductibles, and co-insurance, we go to the next aspect of it that affects certain patients at Champion Performance and Physical Therapy directly: whether we are in-network with your insurance, or out.

In-Network essentially means this clinic (or any doctor's office) has signed a contract with your insurance.  We abide by their rules as far as scheduling and charging for your visit, and they allow patients to utilize their in-network benefit coverage to see us here. Whether or not we are in-network with your insurance is generally determined by whether or not we have the demand for in-network benefits.  If we have enough patients with a certain insurance we are out-of-network with, we'll look into become a so-called "member" of that insurance, or becoming an in-network clinic. 

The reason it's appealing to use in-network is because it is almost always cheaper for the consumer, or in this case, the patient. The deductible for in-network plans are lower, as are out-of-pocket maximums, etc.; both for individual and family plans.

Insurances allow patients to utilize their out-of-network coverage as freely as they do their in-network coverage, but because the deductibles/co-insurances/out-of-pocket maximums are so much higher, it makes more sense for the patients to attempt to locate an in-network provider, instead.

Out-of-Network is more likely to occur with some insurances that may be private, less common, or small, compared to the big-name, widely-renown groups such as Blue Cross or United HealthCare.  A part of membership for providers may require either extensive paperwork, or monthly fees from the provider; which can also lead them to remain out-of-network, despite the demand from their patient demographics. 

How do you know if you have in-network or out-of-network coverage, at all?

You'll call that same customer service line on your insurance card. Many plans include out-of-network coverage, but some do not. Those plans will have lower premiums, and the deductibles can vary from far below average to way above average. 

Keep in mind: having only out-of-network coverage at a specific clinic does not necessarily mean they do not accept your insurance. 

Some clinics, including us, accept certain forms of out-of-network coverage. While we can't speak for other clinics, we, here at Champion Performance and Physical Therapy, will do what's called "match your in-network benefits." 

What this essentially means is, while we are not in-network with your insurance, we will do you a favor and go based on your in-network benefits, instead of your out-of-network.

For example: your in-network deductible is $1000, but your out-of-network deductible is $2000. We will abide by your $1000 deductible, as opposed to the latter. The same goes for co-insurance and co-pay. 

Why do we do this, you ask? 

In some cases, it may be a smarter business decision in the long run with certain plans or insurances. We may not have the demand for that insurance to become in-network, or the plan itself would not benefit the patient or the provider as much as it would in-network. However, our belief in the relief physical therapy here at Champion provides, means we want to open our doors to as many individuals as possible - basically we do it because we don't want your insurance to get in the way of a healthy rehabilitation with us. We urge you to contact our clinic location at 913.291.2290 - and we'll do our best to walk you through this process as you start therapy with us, as well as ensure that you're getting the best "bang for your buck!"

Please note: we accept almost all plans from most major insurances, including: Aetna, Blue Cross Blue Shield, Medicare, UnitedHealthCare, Humana, and more.  Call for more information regarding whether or not we accept your insurance, or specific plan.