Maximum Therapy Benefits

Today’s medical practice reimbursement climate is constantly changing. This makes it difficult to understand the full details of each individual’s coverage and benefits for services. Insurance companies give disclaimers that the information they provide during insurance verification is subject to processing under the plan umbrella, and will be subject to the terms at the time of processing (basically informing us misinformation is possible and they are not liable for it.)

Some providers give patients a form to fill out prior to their physical therapy treatment. They feel this helps the patient understand their benefits prior to treatment. Other providers request all insurance information be submitted to them prior to the appointment so the insurance verification is done before the patient walks in the door. Creating a workflow that works for your office is critical for the patient to understand their benefits and maintain best practices for physical therapy practice management billing.

Here are some things that are important for the patient to understand prior to treatment:

  • The benefit limit for therapy.
  • Whether the benefit is payable by dollar amount, visit limit, or a combination of both.
  • The timeframe for the benefit. Verify the benefits are payable by the calendar year or anniversary date of the plan.
  • Rehabilitation benefits can include occupational therapy, speech therapy, massage therapy, or acupuncture. In addition, physical and chiropractor office can provide and bill for physical therapy services. These services may be paid out of the same benefit limit.
  • It is the patient’s responsibility to track services received from other practitioners in other offices. If the patient exceeds their plan limits, the patient is responsible for payment of therapy services not covered by the health plan.

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