What Insurance Companies Do You Participate With?
- American Specialty Health
- Blue Cross/Blue Shield
- BC/BS PPO & POS
- BC/BS HMO
- Definity Health
- Empire Plan (MPN)
- Health Now
- Meritain Health
- No Fault
- Optum Health
- Secure Horizons by UHC
- Today’s Options
- Total Care
- United Health Care
- Worker’s Compensation
Many insurances are now covering Telemedicine for Physical Therapy without cost to the patient. All copays, deductible and co-insurances are being waived during this period of National Emergency.
If your new balance is not what you had expected by your calculations, there are two possible scenarios. In the first scenario, we have likely received additional Explanation of Benefits(EOB) from your insurance company between statement billing cycles. Once these EOB’s are posted to your account, the additional payment due from you as the patient is then applied to your balance.
Insurance company payments, adjustments and decisions are also labeled with the date of the EOB – For example “08/20/19 United HealthCare payment”
If you received your last statement on 08/15/19, and then we received and posted additional information on 08/20/19, the newly posted date of service will be reflected in the following month’s statement.
In the second scenario, you mailed a payment to us towards your balance from your last statement but it did not posted to your account until after your next statement was generated. While this is rare, it does not happen. For Example, you received your last statement on 08/15/19 and mailed a payment to us 09/01/19. Your next statement might have been generated 09/02/19 but your last payment not posted to your account until 09/05/19. If you think this has happened, you can always call to clarify with our billing department!
In the itemized section of your statement, the far right column labeled “Patient Balance” indicates if there is any balance due by you as the patient for a particular charge line. In that column, any amounts you see with an asterisk are contributing to your total balance as the patient. For example…if a $10.00 co-payment is still due, it will read $10.00* in the “Patient Balance” column to the far right of your statement.
Your statement will also have a grand total of the balance due for the account, as well as a section indicating the required payment for this month.
Also in the “Service Date/Information” column – any payments that you have already made to us toward your copayment or coinsurance amounts will show here…
For example if you paid a $25.00 copay with a check in the office, your statement will read “Check-Personal payment $25.00”
During each session with your therapists, certain activities that you do or techniques that the therapist uses are each billed separately. For example: the time spent working on your exercises is one code billed, while the time spent with the therapist getting stretched is another.
Each of these codes have a separate code associated with them to remain compliant with billing guidelines. We must bill a standard “charge” to ALL insurance companies. The amount that is truly due from the insurance company depends on our contracted maximum amount with them. This means that for every visit a large portion of those charges will be adjusted down to meet that maximum amount.
As a general rule, most insurance companies require about 30 days (or slightly less) to process claims for Physical Therapy. As soon as we receive the Explanation of Benefits (EOB) and payment from your Insurance company, we apply all of the information included on the EOB to your account. If any payment is due from the patient, a statement will be mailed out. Statements are mailed every 30 days on average.
*Note: If you have multiple insurance plans, allow an additional 30 days for each company to process your claims.
On the statement, look to the “Service Date/Information” column of the itemized portion of the statement. This should on the left hand side. This column is where all payments (made both by insurance and by you) are accounted for, as well other adjustments. Insurance company payments are labeled with the company’s name – for example “United Healthcare payment” or “Insurance payment.”
The amount the insurance company paid is also shown two columns over from this labeled “Insurance Payment”
Yes, of course! As we do understand that our itemized statements contain quite a bit of information, our Billing Department will gladly take a look at your particular statement and account in order to answer any of your questions.
Contact any of our locations and ask to speak to a staff member in the Billing Department. Or, you are always welcome to stop into the office with your questions!
Absolutely! It is your right to choose the therapist or clinic you want to treat your condition. If you have a preference, you should let your health care provider know. Remember, not all therapists are the same and you need to select the one that is right for you.
Treatment is initially based on the evaluation findings. Changes in the treatment plan can be made on a daily basis or at periodic re-evaluations. Treatment may consist of hands-on techniques, exercises programs (land, aquatics, or both), and modalities to help relieve pain or inflammation. Home exercises may be incorporated to further speed recovery.
New York State law does not require a prescription for one to receive physical therapy. The requirement is different for each insurance company. It is best to call to be sure if your insurance companies requires a prescription. We can accept prescriptions from an MD, Osteopath, Podiatrist, Dentist, Nurse Practitioner, or Physician’s Assistant.
- Typically, the first 15-20 minutes will be answering questions from your physical therapist pertaining to your specific injury or symptom
- The next 15-20 minutes will include a hand on assessment to evaluate how you’re moving and measure things like the motion of your joints, strength, or balance testing, as well as performing some specific tests to determine exactly what is going on
- Once the evaluation is complete, your therapist will provide an assessment and then work with you to develop a treatment plan specific to your goals that works with your schedule.
- The first session is typically wrapped up with some treatment such as a hot or cold pack, hands-on therapy, or instruction in a brief home exercise program to begin working on before your next appointment.
In New York State, you can be treated by a licensed Physical Therapist for 10 visits or 30 days, whichever comes first without a prescription. At that time, if you need to continue treatment, we can help you contact your medical provider to fax us a script. Of note, most insurances do allow direct access treatments, however some insurances still require a script anyway. Please call us at 315-635-5000 if you would like us to check about your specific insurance plan.
- Your PT script from your medical provider
- Your insurance card(s)
- A list of medications that you take
- The paperwork from our website if you have printed it and filled it out
- Your copay if you have one
- Your calendar so you can schedule follow up sessions
- Plan for the first appointment to last about an hour, and please arrive 15 minutes early if you plan to fill out paperwork at the appointment.
- You can plan for your follow-up appointments to last about 30-45 minutes
- Loose comfortable clothing that you can easily move in
- Clothing that is easy to move/remove in order for us to see the body part you are being treated for
- The sneakers or shoes that you typically wear during the day or during workouts
All evaluations and treatments are performed by licensed physical therapists. When you are assigned to a specific physical therapist, you will remain with that therapist throughout the course of your treatment. At no time will any of your treatment or supervision be performed by an unlicensed clinician.