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.