Win at the Insurance Game - Amazing Results and Save Valuable $$$ by going Out-of-Network for your Physical Therapy!

How to Win at the Insurance Game - 

Get AMAZING RESULTS and SAVE $$$ by going Out-of-Network for your Physical Therapy!

Photo by RomoloTavani/iStock / Getty Images

Photo by RomoloTavani/iStock / Getty Images

What do Baseball, Pac-Man, Monopoly and Insurance all have in common??

Think about it… wait for it… yup, you guessed it.  They’re all games!!

The difference is some are more fun than others and I’m thinking even if you feel Baseball is too boring it still won’t end up on the bottom of anyone’s list.

In all games there are rules/objectives to get to a desired destination.  Whether it be a high score, a victory, ‘owning the board’ or to get to a state of better health.

We are going to touch on the last destination on that list, better health.  Which will specifically bring us to (the game of) insurance and how to win at this game by GOING OUT OF NETWORK for your Physical Therapy...

Rule # 1/The Golden Rule:

The Game of insurance, as a business, boils down to one simple concept: Take in more money (premiums) than paying out (paying for treatments/procedures).

As a patient, the game comes into effect as to how you can use your insurance coverage once you have paid to play. And if you haven’t noticed at all (or greatly noticed!) the rules have changed A LOT in the past 10 years. 

Statistics published in 2016 in Time Magazine show that while in 2006, only 10% of workers had high deductible plans (paying at least $1,000 out of pocket before insurance kicks in), today that percentage is a striking 51-65% of all workers currently!

If this trend continues as it has, more people will be moving to $5,000 -10,000 deductible range (which we are finding to be more and more common).

So with high deductibles like that it makes even more sense to stay in network, right??  Not quite… Since the game has changed, your approach may also need some tweaking if you plan on *winning*

Let’s do some quick stats on Physical Therapy for a High Deductible Plan:

Here is an average fee system for a standard PPO insurance plan on an in-network visit: $45 co-pay each therapy visit (limit 20-25 visits per year) and being in network, you are responsible for 20% of the bill each visit.

An average therapy plan of care includes attending therapy 2-3 times per week for 4–6 weeks for (of course this can vary by extent of current and past medical history for each individual).

Each therapy session lasts about 45-60 min, however most clinics have you work with your Physical Therapist for a small amount of this time and then hand you off to an aide or to do exercises on your own the rest of your session (while your therapist juggles several other patients at the same time). However, you are being billed for the entire time you are there, with an average price of $250-$500 per session.

For our calculations, let’s pick the midrange and say you’re billed $350/session. For most high deductible plans, you are required to cover the full cost of those sessions until you have met your deductible, then beyond that you still have to pay 20% of the session price plus a possible co-pay!

So if you have a 5,000 deductible and have chronic back pain (chronic conditions often times need more sessions!) and need 15 sessions, based on the numbers above, your total would be: 15 x $350 = $5250…

“Congrats!! You have met your 2017 $5,000 deductible!!” Is not the best Title Screen message at the end of this game, especially when you have only been playing for hardly a few months!

It’s like going to an arcade as a kid and popping in $20 of quarters into one machine and only making it through the second level but you have 3 more levels to go. You still want to play more and you wished your money went further in this game! It stunk then and stinks even more now!!

And now for Physical Therapy with a PPO Plan:

These plans often require copays which more commonly are $40-$45 these days. And/Or they will often require you to pay 20% of your bill. So with the same PT plan of care:

15 visits x $45 co-pays each session = $675

20% patient responsibility for the $5250 bill = $1050

If you’re responsible for both the copays and the 20%, yikes.

Every Plan is Different.

Each insurance plan is different. We highly recommend calling your insurance to know your PT benefits before you check out a clinic!

  • Each plan has a different contracted amount of with they will ‘pay’ for PT (despite what the clinic may bill out).
  • Some plans may approve 20 visits per year TOTAL no matter whether you have new injuries or surgeries.
  • Some plans require “authorization” or “pre-approval” where your PT has to send in their evaluation notes for your insurance to determine how many visits they will agree to covering. The down side with this is that more and more plans are requiring PT’s to spend a large portion of your treatment session every 2-3 visits to re-measure everything just to justify you’re making progress. Taking away precious time from treating you!

Speaking of authorization/pre-approval requirements from insurance companies…

Here is another ‘Rule’ to be aware of in play at this time in the insurance game: Tiering

Tiering is when an insurance company or outside review company places different providers in different levels.

They decide they will pay more and require less paperwork for a PT clinic if they:

  • See their patients for less visits on average (it doesn’t matter whether you actually complete your therapy or never return after one visit, your insurance just wants to pay for less visits!)
  • The results of the care doesn’t matter for Tiering (whether you’re actually better or not)
  • They are definitely not giving incentives for good patient care with these rules are they?!
  • If you go to a poor-quality provider for even 3-4 sessions and they send you home with exercises but you feel no better, you probably have wasted possibly around $1,000.
  • Find out what quality therapy looks like and what you should be asking every Physical Therapist (Whether they’re In-Network or Out-of-Network!) via our Free E-Book: How to get GREAT Physical Therapy Without Wasting your Time or Money; 29 FAQ’s Answered at www.BalanceWithinPT.com

But What if There Was a Better Way??? YES!!! There Is!!!!!!

Now before I go on, one thing I would like to clarify is this… Just because you go to a place that accepts insurance, does by no means, conclude you are getting inadequate care. Many in-network providers give great one-on-one care! And if you have met your deductible or plan to, in-network care can be a great option. As with any self- monitored healing journey you must always test (trying some treatment) and re-test/assess (asking, most importantly, yourself, and then your therapist ‘is this benefiting me’?)

We just want to make sure if you are not getting the results you want, we can help you navigate the system to a better place… To give you a boost, like giving you $200 for passing “Go”!

So here is your Power Pellet, Pac-Man (gobble some ghosts!). Your Monopoly Hotels, your ‘Check Mate’ Bobby Fisher… Get greater specialized one-on-one care at an out of network Physical Therapy provider. Why??

  • Full one-on-one time with a therapist (Balance Within has 1 hour sessions)
  • Your Therapist is not under the mercy of the insurance company, performing extra time consuming measurements and paperwork that take away from your care and progress
  • That means greater hands-on specialized care (such as John Barnes’ Myofascial Release) while treating holistically! (“Yes, insurance company, that twisted pelvis and rotated spine is affecting this patient’s neck!”) 
  • Sessions are around $120 flat fee per session (you can still submit this to your insurance to get applied to your deductible, for whole/partial reimbursement, or pay with your HSA!!)
  • LESS SESSIONS are needed – also saving you valuable time and $$$! Our average patient sees us 6-8 sessions TOTAL with a frequency of once/week (more required for more chronic/complicated cases).
  • Small, private clinics don’t have to deal with all the red tape and CAN SEE YOU WITHOUT A DOCTOR’S PRESCRIPTION in Wisconsin! Saving you $$$ to avoid that MD or Urgent Care visit and imaging that may not be necessary. As Doctors of Physical Therapy, we are licensed in WI to see you without a prescription. With our extensive training, we can evaluate you, let you know what might be causing your symptoms and let you know whether there are any red flags that mean you should see an MD or get imaging (Xray, MRI, etc).
  • Small, out-of-network clinics often offer specialized niches, ours is chronic pain/John Barnes' Myofascial Release and Women's Health (many of our patients have tried other clinics with limited results then come to us and we're able to help them feel better, no matter how chronic their condition is!)
  • You're always seeing the same therapist, not jumping around! 
  • BOTTOM LINE: You can get better FASTER!
  • …And can save yourself THOUSANDS of dollars!!!

And so with that power-packed info, for your physical ailments there is plenty to gain…  So take control of your health and win the game!! 

***Walk-Off Home-Run***

…Bat drop……

 

All our Best Wishes,

Drs. Jereme and Sarah Trunk, PT, DPT

 

P.S. Whew! This is a complicated topic and this was only the tip of the iceberg! As always, please know we are here to answer your questions! And for more details we highly recommend you check out our Free E-Book: How to get GREAT Physical Therapy Without Wasting your Time or Money; 29 FAQ’s Answered at www.BalanceWithinPT.com (This book includes insider tips with questions to ask ANY Physical Therapy clinic to make sure you'll get GREAT care. There are all sorts of clinics so you'll want to be sure you know how to find the one that's perfect for you!)

Women’s Health Physical Therapy and Myofascial Release

Women’s Health Physical Therapy & Myofascial Release

By: Dr. Sarah Trunk, PT, DPT

Did you know that 50% of all women believe pelvic floor dysfunction is normal?

...Think of urinary incontinence/leakage, pelvic pain/pain with intercourse, pelvic organ prolapse, painful periods, chronic pain after pregnancy, etc. These conditions can put a serious wrench in your ability to enjoy your life. 

The good news is that specialized Women’s Health Physical Therapy and Myofascial Release can help! That’s right – no surgeries or drugs or wearing pads for the rest of your life!

Continue reading to learn more…

 

How Physical Therapy & Myofascial Release Helps Common Women’s Health Conditions:

  • Urinary Incontinence (aka Leakage) & Urinary Urgency: 

    • Muscles control these functions in your body too! Sometimes the pelvic floor muscles need to be strengthened, stretched, trained to have better coordination or sometimes we need to address our bathroom habits to train our bladder. A skilled Women’s Health Physical Therapist will assess these components and help create a treatment plan. John F. Barnes’ Myofascial Release can also be helpful to gently decompress the muscles and connective tissues in this region to take pressure of the bladder.

  • Pelvic/Hip/Low Back Pain: 

    • The pelvis is an especially complex area of your body and deserves a specialist! Properly addressing the pelvic floor muscle function and releasing tight fascia (connective tissues) in this region are often extremely important missing links to relieving pain in the back, hips and pelvis (they’re all connected!)
    • Dr. Sarah and her husband Dr. Jereme both specialize in the John F. Barnes’ Myofascial Release Approach. This link will fill you in nicely on how this approach is an especially helpful missing link for chronic pain: www.balancewithinpt.com/fa

  • Pelvic Organ Prolapse: 

So... Are you surprised that Physical Therapy can be helpful for these Women’s Health Conditions? Most women are! It's really a shame this isn't talked about more. 

And this information is only the tip of the iceberg! Women’s Health Physical Therapy & Myofascial Release (MFR) can also be especially helpful for these other common conditions:

  • Pain with intercourse
  • Painful periods and Endometriosis/Ovarian Cysts
  • Fibrotic/Fibrocystic breast tissues
  • Constipation
  • Recovery from a difficulty pregnancy/delivery
  • Gently releasing C-Section & Episiotomy scars
  • Mastectomy/lumpectomy scars & lymphedema

Imagine all the things you could enjoy more in your life without these annoying problems! And with natural treatments... no surgeries, pain meds or pads which just treat the symptoms! Just highly specialized Physical Therapy and Myofascial Release to get to the CAUSE of the problem. 

Interested in learning more?

Find out even more about how Women’s Health PT and MFR can help with these conditions by signing up to be notified of Sarah’s upcoming eBook guide:

10 Surprising Conditions That Respond GREAT to Women’s Health PT and Myofascial Release

This eBook will be released in the next few months with a limited number of FREE copies, SIGN UP HERE for our newsletter to be the first to claim your FREE copy!
 

Last of all, Thank you for your curiosity! Please consider sharing this important information to the ladies you love in your life. We don’t talk enough about these conditions but there is no need to suffer in silence! Please know I am here for you should you have any questions or concerns.

Warmly,

Dr. Sarah Trunk, PT, DPT
email: DoctorTrunk@BalanceWithinPT.com, phone: 262.442.5054

*For More Info About Dr. Sarah Trunk, PT, DPT and her practice at Pathways of Light Wellness Center, please visit:  www.balancewithinpt.com/aboutus/

P.S. Don't forget to sign up for our Newsletter to be notified of Dr. Sarah's upcoming eBook guide HERE! 

Pathways Holiday Boutique Saturday, December 3rd from noon-5pm

 

Sarah and Jereme will be offering FREE 20 minute discovery sessions for new and returning clients! Are you or a loved one suffering from pain limiting the ability to enjoy life? Find out how we can help. No pressure, just helpful information for you or your loved one to find out how you get back to more life in your living! 

Come visit Sarah & Jereme at the Pathways Annual Holiday Boutique this Saturday, Dec. 3rd from noon-5pm!