Insurance Companies Love 'Em or Hate 'Em

Insurance Coverage for Physical Therapy

The best way to take care of your health is to take an active role in your own health care. To do this, you need to know about your options and your rights as a patient. Patients are becoming better educated and demanding more and better options from their health insurance companies. The right to physical therapist services is an important option, and it is your right as a patient. Today, even Federally qualified HMOs are required to have physical therapy in their benefits packages. Look below at our list of companies that offer excellent benefit packages. Is yours on the list?

Why Physical therapy?

Physical therapists are experts in how the musculoskeletal and neuromuscular systems function. Physical therapist services are cost-effective. Early physical therapy intervention prevents more costly treatment later, can result in a faster recovery, and reduces costs associated with lost time from work. Patients pay less when they have direct access to physical therapy services. A study conducted to determine whether direct access to physical therapy services was cost-effective found that patients who went directly to a physical therapist had fewer episodes of care, and services were ultimately less costly. Checking is easy, Call us today 480.607.7662 and we will check your benefits for you, before you even come for your first treatment.

 

Health Insurance Coverages

Click on the appropriate Link below and follow the steps to check you health benefits.
You will need your ID #, Group Number, Name & Birthdate of the Primary Insured.

Most Insurance companies offer 30 to 120 visits for physical therapy. The following list is insurance companies were we participate in thier network. and Companies that we accept coverage for but we are not in their network yet.

 

Arizona Business' that offer Good Health Insurance Coverages

Below is a list of local companies that we have had the pleasure treating their employees.

Most of these companies health insurance plans cover 60 to 120 visits for physical therapy.

Understanding Insurance Companies Language

Insurance Coverage for Physical Therapy

Articles written about insurance and reimbursement can read like a foreign language text if you are not familiar with the terminology.  With the advent of managed care, patient’s can only see providers who are part of the insurer's network.  Regardless of the provider's fee, payments are limited to a set maximum allowable amount by the insurance company. Either the provider or the patient is responsible for the difference.  Typically in the Arizona, the managed care contract has a "hold harmless" clause, so the provider is responsible for the remaining balance and cannot collect that money from the patient.  Therefore the patient cannot be "balance billed" for the remainder. 

Here is a glossary of common terms associated with insurance companies:

Balance billing: the practice of holding the patient financially responsible for the remainder of medical service charges, beyond the insurer's allowed amount.  Does not apply when a managed care contract contains a "hold harmless" clause, which is typically the case.

CMS: Centers for Medicare and Medicaid Services.

Co-insurance: the monetary amount to be paid by the patient, usually expressed as a percentage of charges

Co-payment: the monetary amount to be paid by the patient, usually expressed in terms of dollars

CPT-4: Current Procedural Terminology, Fourth Edition.  5-character, numeric codes assigned to nearly every health care service/treatment. 

Deductible: the portion of medical costs to be paid by the patient before insurance benefits begin, usually expressed in dollars.

Denial: refusal by insurer to reimburse services that have been rendered; can be for various reasons

Eligibility: the process of determining whether a patient qualifies for benefits, based on factors such as enrollment date, pre-existing conditions, valid referrals, etc.

Fee for service: reimbursement method in which each health service is paid on an individual basis.  Charges may be paid in full by the insurer but in most instances are paid on a percentage basis. 

Fee schedule: a pre-determined list of payment amounts for various services; may be based on UCR, RBRVS or other method

Gatekeeper: in managed care, it refers to the provider designated as one who directs an individual patient's care.  In practical terms, it is the one who refers patients to specialists and/or sub-specialists for care.

ICD-9: International Classification of Diseases, Ninth Edition.  Numeric and alphanumeric codes for numerous diagnoses

Managed care: a method of providing health care, in which the insurer and/or employer (policyholder) maintain some level of control over costs and utilization by various means.  Typically refers to HMOs and PPOs

Payer: the party who actually makes payment for services under the insurance coverage policy.  In the majority of cases, the payer is the same as the insurer.  But, as in the case of very large self-insured employers, the payer is a separate entity under contract to handle the administration of the insurance policy

Policyholder: purchaser of an insurance policy; in group health insurance, this is usually the employer who purchases policy coverage for its employees

Provider: one who delivers health care services within the scope of a professional license

RBRVS: Resource Based Relative Value System.  Reimbursement method used by the U.S. Health Care Finance Administration (HCFA) for its Medicare program.  Values for each medical procedure are based on the amount of resources required to perform the procedure, then the values are weighed against each other to compute relative values.

Reimbursement: refers to the payment by the patient (first-party) or insurer (third-party), to the health care provider, for services rendered

UR: utilization review.   Retrospective review of a patient's course of treatment, to evaluate the appropriateness of care based on medical necessity.