Rates/Insurance

As complex as the topic of insurance can be, we will keep it short.  What people don't know or understand is that insurance companies, more often than not, dictate therapy treatment.  How is this?  REIMBURSEMENT.  In-network clinics often dictate their treatment around what the highest reimbursement rate is and not around what yields the quickest and most effective results.  So being an independent out-of-network provider allows us to stay away form any outside influencing factors that could sway any therapeutic outcome. 

Let's look at an example of this.  Have you ever performed therapy at an in-network clinic because your insurance covered it?  While you were there did you notice that often times patients overlapped or you worked with someone besides the evaluating therapist?  A big reason for this is insurance companies will only reimburse for a certain, or set, amount of time spent with individual patients. 

Example:

Insurance company A only reimburses two unit(approximately 30 mins) of physical therapy.  As a patient you most likely don't know this.  What this means is that your insurance company is only paying a set amount no matter if the visit is 60 mins.  Visits for therapy usually consist of an hour session, but you'll often notice that you, or others around you, are working with a tech or doing your home exercise program independent in the gym.  Why is that?  The reason is because the business is only going to be paid for approximately 30 mins of treatment, so the remaining 30 mins of treatment is not reimbursed.  Essentially then the company will suffer not being paid for half of the time spent with patients.  SO, in order to make up for the 30 minutes of your hour that is not reimbursed patient will overlap or therapist will double up patients.  That's why you will notice therapist treating multiple patients at once, but only spending one-on-one time with one of them.  Business is business, and maximizing you bottom line is import  This is just one prime example of how reimbursement can influence patient treatment and outcomes.   

Our treatment model focuses on the patient and the outcome, and not on the insurance payment.  

You may also think  that going out-of-network is going to cost you more since you are paying out of pocket when you have insurance, but that may not be true either.  Since insurance companies are going to higher co-pays you might end up paying just as much or even more going to an in-network therapy office.  

Example:

You just started therapy and your plan of care suggest that you come to therapy for 2-3 x's/week for the next 4 weeks.  Lets say that you decide that you want to go three times for the next two weeks to see how things go.  If your co-pay is $50 each time you will end up spending $150 for just one week of treatment.  Also, if you have not met your deductable you will pay the full amount until your deductible is met.  This could mean that you end up paying the price for in-network therapy which on average could cost $200 a session, and not even all of that counts towards your deductible at times.  And to makes things sting more, insurance often takes 6-8 weeks for it to be submitted and billed so you don't receive a bill for all this until you're already deep into your treatment.  

This all may seem like a lot of information but understanding insurance can be that way.  Our treatment model stays true to what has been shown to work!  We value to importance of managing patients time in the clinic in order to be the most effective so that you end up spending  less time outside and get back to the life you always imagined.  

For further any questions on billing and rates please contact us. 

If you receive health insurance in the form of medicare this is important to read.  The government and medicare work together to make sure that their money is being spent where they would like it to be spent.  If you are enrolled in this system you need to understand that we are no enrolled with medicare in any way.  The only way that we can accept Medicare patients is if they willing and knowingly give up their right to be billed under Medicare for any physical therapy services.  Patients need to request to not be billed for their service and must willing give up this right before any treatment.  

So those who carry medicare as their insurance need to truly want to see us and we can help. Patients who want treatment from Midline must ask us up front not to bill Medicare and request that they do not want Medicare to be involved in their PT care at all. 

Those who do not want to give up being billed under Medicare cannot be treated at Midline Movement, and must find another provider within the Medicare networks.  We are more than willing to help find another provider is the area.