Do I need a referral or prescription from my doctor?

Both New York and New Jersey have Direct Access laws which allow you to see a physical therapist for 30 days or up to 10 visits in a 30 day time period without a referral. After 30 days, a patient will need to obtain a prescription if physical therapy is to continue.

The caveat to this law is that many insurance companies, including Medicare, require a prescription or a referral to physical therapy in order to pay for the visit. At this time, we do not participate in any insurance plans and are considered an out-of-network provider. Therefore, we do not need a prescription at the time of your evaluation. Please read below for further clarification.

Do you take insurance?

Due to our practice structure (traveling to the home or providing one-on-one care in the office), we are considered an out-of-network provider with all private insurance companies. If you have out-of-network benefits, we will provide you with all of the documentation needed for reimbursement. If you do not have out-of-network benefits, you will not require any documentation as reimbursement is not possible. In both instances, payment is due in full at the time of service.

We are, however, a proud Medicare provider. Please understand that in order for physical therapy services to be reimbursed, objective improvement must be observed and physical therapy services must be deemed “reasonable and necessary”. At the time of this writing, telehealth visits are covered services. With some exceptions, all outpatient physical therapy services have an annual monetary cap. In the event that this cap is met, the patient then becomes responsible for full payment at the time of service.

Please understand that wellness programs are NOT considered “normally covered services” by Medicare and would be subject to payment in full at time of service with any in-network Medicare provider.

Updated 7/21/20

Why should I use my out-of-network benefits?

The benefits are two-fold.

Rising healthcare costs are characterized by increasing co-pays and higher deductibles in the setting of declining quality of care. By utilizing your out-of-network benefits, you are contributing to your deductible and obtaining the benefits of one-on-one treatment sessions up to 60 minutes in length. As a result of individualized care, a person will benefit from therapy at a reduced frequency, oftentimes just once a week. In a more traditional setting, a patient may be seen 2 or 3 times a week and be responsible for a daily co-pay and at times, coinsurance payment. This often results in a greater cost to the patient in comparison to the cost of a one-on-one session.

Further consideration needs to go into the maintenance of proper social distancing requirements as well as disinfecting treatment areas in the current healthcare environment. We follow the CDC’s guidelines for clinic preparedness in order to maintain the highest hygienic standards in addition to offering in-home or telehealth visits.

How do I obtain reimbursement for my out-of-network benefits?

Insurance is not filed by our office; however, we will verify your benefits for you. There are two options available to you in order to obtain reimbursement.

Traditional reimbursement for out-of-network care would involve providing you with a “Superbill” which contains all the information required by your insurance company to process and provide payment to you for your claim. Each insurance company differs in their process and would involve you contacting your insurance company directly and submitting the Superbill as directed.

Alternatively, our practice has partnered with a company called Reimbursify. Reimbursify submits out-of-network claims on your behalf for only $1.99 per claim. Once you download the app and answer a few questions, you upload a picture of the Superbill provided to you and then submit. Not only does Reimbursify alert you when the claim has been received by your insurance company, but they also inform you of when you should expect your reimbursement check in the mail. This usually takes between 2-4 weeks. They will also assist you in any instance of reimbursement rejection. We highly recommend utilizing Reimbursify in any instance where a healthcare practitioner does not directly file your claim.

I have more questions, how can I contact you?

We are available to answer any and all of your questions. We also offer a free 20 minute phone or video consultation to help you determine if Ebb and Flow Physical Therapy matches your healthcare needs.