Insurance Information
Which insurance is Empower PT and Wellness IN Network with?
Cigna
BlueCross BlueShield
TriCare (Authorized Provider)
Why did our practice make this decision?
This was not a decision taken lightly. Over the past several years, a lot has changed with the relationship between providers and insurance companies. These changes have resulted in lower reimbursement on our end and decreased coverage for the patient. These restrictions have changed how we treat our patients over time (for example, we need to see multiple patients an hour in order to be profitable). We care deeply about giving our patients the time and care they deserve. Our goal is to offer quality one-on-one care. In which we believe will help our patients heal more effectively and efficiently. We realized the only way we could keep a relationship with our patients we could be proud of was to remove the insurance restrictions under which we were practicing.
What is the difference between IN and Out of network provider?
If we are an Out-of-network provider this means instead of our clinic billing the insurance directly, at each visit an invoice will be provided to you. This simply means that the therapist has not entered into a contract with an individual insurance company to receive reimbursement based on their contracted rates. There are MANY insurance companies, each with their own contracted rates and regulations. It is important to note that in- network provider status is not currently based on education, experience, skills, or treatment outcomes, but is often determined by the number of providers in a demographic area.
How do I get reimbursed through insurance?
You pay at time of service and are given a super bill.
You will then turn in this invoice to your insurance company for out-of-network reimbursement depending on your policy. The invoice has all of the necessary information (business name and address, tax ID, national provider identification, license numbers, etc.) as well as the patient’s ICD-10 (diagnosis) and CPT (billing) codes. You may choose to submit bills following each visit, one time per month, or at any other interval, typically up to one year following your treatment visit.
Won’t I be spending too much ?
You will find that the out of pocket costs are similar to in-network co-pays when you factor in the frequency of 2-3 visits a week and with on average 15 minutes with the therapist per session versus up to one hour long session once a week that produce effective results in less time and are sustained by home exercise programs.
My insurance carrier is Medicare. Am I able to see you for PT?
Under current Medicare regulations, it is illegal for a physical therapist to accept cash pay from Medicare patients for skilled PT services that may be covered under Medicare, even if the services provided meet all treatment, documentation, and HIPAA requirements and have been prescribed by their physician.
At the moment it is difficult for patients to not use their Medicare benefits. As a Provider that has opted out of Medicare if I treated someone who later used my superbill for reimbursement with their secondary insurance it would end up going to Medicare and then I would be fined significantly per visit.
WE are only allowed to do unskilled PT such as wellness programs or for services not provided under Medicare such as Laser treatments.
As recently as July 2021 Medicare announced a almost 20% cut in payments to PT however no decrease in paperwork and rules. Failure to comply with Medicare rules in every case, even with best intent, could result in a federal investigation, fines, or other legal action. The Medicare Benefit Policy Manual is available in full as a series of downloads at CMS.gov; outpatient physical therapy benefits are discussed in Chapter 15, which is currently 289 pages.
There is the real hope and possibility that the laws concerning Medicare outpatient PT benefits will change.
What does Direct Access mean?
No need for a doctor prescription can be seen for up to 60 days. This is great news saving time by not having an extra appointment and starting PT earlier. I have been trained in Direct Access evaluation which means if I see anything concerning that would not be treatable in PT I refer out immediately.
Such as any suspicion of fracture or systems of pain not coming from orthopedic complaints.
The bottom line is, we want to be able to give you all the care you deserve. Without the restraint of insurance, we feel confident that we can do this. Please feel free to respond to this email or call the office if you want to learn more about what this means or if you have any specific questions.
**We provide you with a Good Faith Estimate in writing if you are Self-pay or uninsured so there will be no surprises in billing.**