Healthcare insurance is a hot topic of late, and is always a conversation we have with our patients when they start outpatient physical and/or occupational therapy with Advance Therapy. However, insurance is often confusing, complicated, and overwhelmingly variable in what is covered depending on the patient’s plan. Often, insurance limitations can create barriers to access services that can greatly benefit and improve a person’s life. How do we navigate insurance benefits in therapy?
We begin with verifying your insurance benefits when you call to set up an initial evaluation appointment. You will provide your plan information, and our billing specialist will contact your insurance company and find out what exactly your benefits are. However, we always suggest that YOU also call them and discuss your benefits, so you know what to expect.
Sometimes, a plan may only pay for specific services or have a limit on the number of visits you may use per year. Often, therapy visits are linked to medical necessity. Generally, services are considered medically necessary when they:
- Are an appropriate, safe, and effective treatment for your diagnosis or condition.
- Meet your medical and functional needs.
- Align with the general standards of health care.
Some plans limit your out-of-pocket cost for each visit to a co-payment, and others require you to pay for part or all of your visits until you have reached your yearly deductible. After that, the insurance plan typically pays 100% up to their set limit.
Accessing Therapy Services:
Wyoming is a state where there is direct access for physical and occupational therapy. This means that you do not have to have a doctor’s referral for therapy services, legally. However, some insurance plans require you to get a referral from your primary care provider before they will pay for services (Medicare, for example).
If you do not have insurance, or if your plan does not cover physical/occupational therapy, you can still see a therapist by paying directly. Self-pay is also an option if you choose to see a provider who is not in your health plan’s network.
So, overwhelmed yet??
We completely understand! We are here to help! A large part of the reason we check benefits and talk to our patients at the beginning of therapy is so that we can help overcome any financial barriers to getting services that will positively affect the function and quality of life of those who come to us for help. We want to help you navigate insurance in therapy to maximize your benefits!
How can we help YOU today? Give us a call and let us help navigate those confusing insurance waters!