Every year most of us are faced with a new deductible that needs to be met prior to our insurance initiating payments for our medical care. Deductibles can range from $150.00 to $20,000. This is crazy! 20 plus years ago when we first opened our doors, outlandish deductibles were $2500.00. Unfortunately, $5000.00 or more is the norm, and we must manage our finances and therefore our healthcare. Some companies offer an HSA or FSA accounts to help employees with deductibles. In the end, it would be great if we could have a savings account that had a balance that was equal to or greater than our deductible accruing interest and then available to us when we need it to pay for medical expenses – but this isn’t a reality for a lot of people.
At Four Pines PT we work towards assisting our clients with navigating the health insurance world. We are happy to call and obtain your benefits, but we have limited access to information and it is not a guarantee of benefits. We suggest that you call the number on the back of your card and ask about benefits as well. Please call us at 307-733-5577 in Jackson or 307-654-5577 in Alpine if you need more information about your insurance.
Below is some basic information that may help you understand your insurance
INDEMINTY INSURANCE (Blue Cross Blue Shield, Cigna, Aetna, et al)
As a courtesy our front desk staff will call your insurance to verify your physical therapy benefits. Unfortunately, this is not a guarantee of benefits. Four Pines Physical Therapy is an in-network provider for Blue Cross Blue Shield, First Choice of the Midwest, United Health Care, and Cigna (Open Access Plus), however, we accept and bill all insurances. Some companies require pre-authorization prior to treatment which in some cases may take up to 5 days. You may need to contact your insurance company for the pre-authorization.
At the beginning of your deductible year, you will be financially responsible for your treatments minus the contractual adjustments that we may have with your particular insurance company. Once your deductible is met, then you may have a co-insurance or co-pay amount until you have met your out of pocket expenses. For some insurance companies, once your out-of-pocket is met, your treatments may be covered at 100%! Other insurance companies only require co-pays at each visit. Your insurance company may send you a letter or EOB (explanation of benefits) asking if you have any other insurance or if your care is from a work injury. This letter needs to be signed and returned to your insurance company in order for them to process your claims, otherwise, you claims may be denied and you will be responsible for the cost of your treatments.
In Wyoming, you do not need a physician prescription to come to physical therapy. Why not start your treatments immediately by making an appointment with your physical therapist, rather than waiting a week or more to see your physician, longer for an xray/MRI only to be referred to PT 4-6 weeks later. As medical professionals, physical therapists are skilled at screening, evaluating and making a physical therapy diagnosis for orthopedic care and practice within the scope of our practice act/license. If you need more advanced medical care we will refer you to the most appropriate physician and help you get an appointment in a timely manner.
Medicare beneficiaries must obtain a physician referral for physical therapy to be seen by a physical therapist. Medicare has a threshold on combined Speech/Physical Therapy benefits in 2019 which is $2010 for the year and $2010 for Occupational Therapy. You may exceed this threshold if your care is deemed skilled and medically necessary as deemed by your physical therapist, not your doctor. There is another threshold of $3000.00 which would trigger a medical manual review. It is considered fraud and abuse by Medicare to bill for services that can be performed on your own or by a care giver at home. Medicare covers maintenance care which is physical therapy care to prevent / slow down the physical decline due to a chronic and or progressive disease. Medicare has strict and clear guidelines on how this can be offered.
A Medicaid beneficiary is required to have a physician referral by a WY Medicaid participating physician. Unfortunately, we are not able to see Medicaid beneficiaries from other states. At this time, there is a 20 visit maximum for physical therapy benefits which need to be skilled and necessary as deemed by your physical therapist.
We accept all worker’s compensation policies, State and Federal. Federal worker’s compensation requires pre-authorization after the initial evaluation.
Four Pines Physical Therapy hopes that this helps you understand your health care benefits. As always, we encourage you to call you insurance company for clarification of benefits. We are more than happy to help explain your benefits and help you navigate the insurance world!
We Wish Everyone a Happy and Healthy New Year!
Four Pines Physical Therapy Team