Frequently Asked Questions
What are you hours?When is your first appointment? When is your last appointment? What kind of insurance do you take? Do you offer massage therapy? What is a Functional Capacity Evaluation? What is Direct Access and how does it affect me? What is the Medicare cap? What's the difference between a co-pay and co-insurance? What is an EOB? What are you hours? Our hours are Monday through Friday from 8 a.m. to 5 p.m. When is your first appointment? The first appointment of the day depends upon whom your therapist is but is generally scheduled between 8 a.m. and 9 a.m. When is your last appointment? Because our office is open until 5 p.m. and most appointments last around one hour our last appointment is generally at 4 p.m. What kind of insurance do you take? We accept many different insurance plans but, because plans vary from employer to employer and with different individuals, we verify your eligibility, coverage, deductible, and co-payment, to the best of our ability. This is not, however, a guarantee of what your insurance will pay. We always recommend you contact your insurance company yourself to verify coverage, and inform us if the information you receive is different from what we have been told. These are some of the insurance companies we accept:
United Health Care, Tri Care (Tri West), and Aetna are out of our network. If you are a member of one of these providers please contact us for other payment options. Do you offer massage therapy? Therapeutic massage is often part of the therapy process although it is not offered as an individual service. What is a Functional Capacity Evaluation? A Functional Capacity Evaluation is a series of tests measuring physical strength, range of motion, stamina, and tolerance to functional activities, including lifting and carrying. These tests can be used to evaluate work tolerance, and the necessity for work restrictions. This type of evaluation is not covered by insurance but can be paid for out of pocket or by workman's comp. What is Direct Access and how does it affect me? Direct access to Physical Therapy services means you are able to see us for Physical Therapy without a referral from a physician. In New Mexico, legally, you do not have to be referred to us by your physician to receive services. Of course, most insurance will not pay for services without a physician referral, but that is changing. Right now if you self pay or have HMO NM insurance you do not need a referral. Many insurance companies tell us that their customers have not asked to have the right to self refer for Physical Therapy, even though we hear that wish all the time. Please call your insurance company, or if insured through work, tell your human resources director, that you would like your plan to allow you to self refer to Physical Therapy. The Medicare Patient Access to Physical Therapist Act recognizes the ability of licensed physical therapists to evaluate and treat beneficiaries requiring outpatient physical therapy services under Part B of the Medicare program without a physician referral, if direct access is authorized by state law in the state in which the therapist practices (It is in New Mexico). As this bill comes up regularly in Congress, please urge your Congressman/ Congresswoman to support Direct Access to Physical Therapists. Many times patients are referred to orthopedic surgeons by their primary care physician and hundreds of dollars are spent on needless MRIs and expensive medications. A physical therapist can usually identify the problem and provide the necessary course of treatment for much less than the cost of a single MRI, and without incurring the side effects of medication. APTA believes improving access to care for beneficiaries is critical as Congress looks to reform the Medicare program. What is the Medicare cap? Medicare has a cap, or limit, on how much they will pay for physical therapy, occupational therapy, and speech therapy in a one-year period. The limit as of January 1, 2006 is $1,740 for Occupational Therapy per year. Physical Therapy and Speech Therapy must SHARE this amount, due to a poor attempt to include speech services at the last minute when the bill was drawn. This has never been corrected. Medicare has implemented an Exemption Process, which allows the cap to be exceeded when the patient requires both Physical Therapy and Speech Therapy simultaneously. For some other conditions Medicare has also allowed exemptions. For many diagnoses however, the cap remains in existence. This poses payment issues for providers such as us, and for you. If you have been seen by another provider in the calendar year, that uses up part of your cap, but it is difficult for us to access that information so we can accurately inform you of when your cap has been met. At that point you become responsible for charges incurred, unless you are being treated under an exempt diagnosis. Complicated! We agree. What's the difference between a co-pay and co-insurance? A Co-pay is a set amount per visit and is usually predictable, unless your insurance company provides us with incorrect information -- WHICH DOES HAPPEN! We usually will not find this out until we receive a payment from your insurance company with your copay listed. Co-insurance is a percentage of what the insurance contracted amount is. This is very difficult to determine accurately at the time of the visit, as each insurance company pays a bit differently. For that reason we charge an estimated amount at the time of service. Once we receive the payment for that date of service we will bill you the additional amount or refund the overpayment if that is the case. We must go by what your insurance company has received and allocated to your deductible, even if you feel your deductible has been met. If you paid another provider, but they did not bill until a month later and we bill first, your insurance company will apply your deductible to our service, and the other provider will be required to refund you any deductible payment you made to them. Believe us, we feel your pain. A significant part of our cost is keeping up with insurance company rules, different payment standards, and billing processes. We know it is difficult to understand. We will help you as much as possible. What is an EOB? You should receive an EOB -- explanation of benefits -- from your insurance company each time they make a payment to us. We receive that also. Generally in any medical office the provider will receive 60 percent or less of what is actually billed. The EOB will say what the provider is paid based on our contract, what we must adjust, or "write off" and what you owe for each date of service. It will say what is applied to your deductible and what your copay or coinsurance is. If you have a secondary insurance company, we will usually bill that for you, and not require payment at the time of service. If you have a third insurance company, which occasionally people do, you will be responsible for submitting to that insurance for any additional payment. We can only provide billing for a maximum of two insurances. If your insurance is a company with which we are not contracted, their payment schedule may be different from what our normal contracted payments are. In that case, what you are responsible for will be the difference between our charge and the insurance payment, regardless of what the insurance company may tell you. Our noncontracted fee schedule provides a discount for our patients who use noncontracted insurance companies. This basically provides the "write off" up front so total payment amounts, that is the combination of what you pay and the insurance pays, are similar to contracted companies. |