by Dr. Erin Carr, September 7, 2015
Many people ask “How Can I Find The Best Physical Therapy Near Me” (Part 3 of 3)
3) “Physical Therapy Near Me” – What To Ask
Once you are talking, person to person, with the Physical Therapy Clinics near you. Here are some good questions to ask that will help you gain a clearer understanding as to which of them may be the best choice to answer your question “who is the best physical therapy near me”.
–How long are the physical therapy treatments? Depending on the clinic, most patients receive somewhere between 30 minutes to 1 hour for each of their appointments. If you are able to find a clinic that guarantees the longer time for each session. The additional time can have added benefits in your healing process.
–How much of each of your treatment time is spent with an actual Doctor of Physical Therapy/ Physical Therapist? Some clinics pack in the maximum number of patients per hour. In that type of situation you may only be seeing an actual licensed PT for 15 minutes of your physical therapy sessions. The rest of the time you usually will be put on ice, or on machines, receive electrical stimulation, get massage, or be placed with a physical therapy assistant/aide to complete the rest of your treatment. However if you can find a physical therapist, in your area, who guarantees the majority of your time spent, will be with actual physical therapist. That can also be a big plus for injury recovery.
–Does the clinic offer off site home physical therapy treatments? If you want to find the closest physical therapy near you. It does not get much closer then from the comfort of your own home. Check out my other blog on home health physical therapy vs. home physical therapy for more clarification about the home care physical therapy options that are available. As part of finding the answer to you question “how can I find the closest physical therapy near me,” ask the clinic if they offer off site physical therapists in home. If so, what are the costs associated with home physical therapy.
-What type of physical therapy treatment methods do the clinic’s therapists utilize? There may be many different types of physical therapy treatments that you may find when answering your question who is the best physical therapy near me. There are traditional western, alternative, integrative, hands on, orthopedic, holistic, visceral, machine based, and exercise based to name a few. There are also different categories such as pregnancy, post postpartum, pediatrics, seniors, post surgical, women’s health, athletic, balance, stroke rehabilitation, brain injury recovery, pain management, and many more. Some of the best physical therapists, you will find, can treat patients in any of these categories. I have found usually the best healing results for patients, are results of integrative hands on physical therapy treatments for all the categories. However, the other types of treatment methods do have some merit as well. You can do your research and decide what you think will be the best physical therapy methods for your personal preference and situation.
-Is the physical therapy clinic in network or out of network for your specific insurance company and policy?
When answering your question what is the best physical therapy near me. Taking into consideration whether or not to try to get your physical therapy treatments near you covered by your health insurance can be an important factor. Here is how we have come to understand this issue…
“In network” usually means that the individual clinic near you is under contract with certain health insurance companies. And usually the health insurance company will pay the physical therapist directly for most or all of the costs associated with your PT treatments after your deductible has been met (up to a certain cap for the year). Usually with in network physical therapy, for each visit, there is some type of co-pay that the patient is responsible for. The co-pays vary widely depending on the specific plan and health care insurance company that the patient has. In network co-pays can range from the patient only having to pay a small percentage even before the deductible is met… To the patient having to pay the full price until the deductible is met.
“Out of network” usually means that the Physical Therapy clinic near you is not under contract with the health insurance company and the patient will be required to make payments directly to the physical therapist for each of their physical therapy treatments. There is also a gray area in out of network physical therapy that is important to understand…
In the gray area, some health insurance policies will actually still pay the physical therapists a portion of the cost of the out of network treatments once the patient’s “out of network deductible” has been reached. This out of network deductible is different than the insurance policy’s normal in network deductible. And reaching it can only be achieved if the patient has paid for other out of network medical services from of the patient’s own pocket for a calendar year. This can be a bit confusing when trying to find an answer to “where is the best physical therapy near me” so let’s delve a bit deeper…
If a patient decides to receive treatment from other medical doctors or practitioners who are also out of network, these visits along with any testing they do including blood work, IV drips, and lab tests can all contribute toward your out of network deductible. Also included in this list can be out of network physical therapy where the patient starts the year paying out of pocket. But once the patient reaches their out of network deductible, then for the rest of that calendar year, either a portion of, or all of, the costs of each out of network PT treatment will be paid (up to a certain total payable capped amount for the year which the insurance dictates).
You should be able to be find info on this within the contract of your specific insurance policy contract… Or by you contacting your insurance company directly.
To explain further, let us say a patient’s insurance policy has a $5,000 out of network deductible with a $10,000 cap for out of network procedures/services per calendar year. And, for example, at the beginning of the year the patient under goes various testing and lab work through an out of network medical doctor. If the cost of multiple doctor visits and lab testing equals $2000, part or all of these costs incurred will contribute to the $5000 out of network deductible, reducing the deductible by $2000 or less. Any other treatments or visits by other out of network doctors or practitioners, including physical therapists, will continue to help reduce the deductible until it reaches a $0 balance.
However, an important caveat to this… The out of network $5000 deductible, is offered differently, depending on your insurance. Some health insurances will cover the entire cost of the each visit until the $5000 out of network fund is depleted. While other insurances will only cover a portion (sometimes a very small portion) of the cost of each out of network visit until the $5000 is depleted. Either way, the cycle starts over each calendar year. In January the out of network deductible resets along with the traditional in network deductible.
The insurance reimbursements, after the deductible has been reached, usually happen in one of two ways for out of network physical therapy. First, the physical therapy clinic may offer a billing service to the patient in which the clinic contacts the insurance company to receive payment. Then after the PT clinic sees what insurance paid. The clinic will bill the patient for any portion of the visit costs that insurance did not cover. Or secondly, the patient will pay the physical therapist directly, up front, and then the therapist will provide the patient with what is called a “Super bill” for each visit. Then the patient will personally send in each super bill, to their insurance company, and request reimbursement. After the insurance company receives the super bill. They will send a letter or check to the patient explaining how much they are willing to reimburse the patient for.
As mentioned earlier the amount insurance is willing to reimburse varies greatly on how good of an insurance policy you have. Some policies may only be willing to pay $15 per visit while others will pay in full for each out of network visit up to a certain cap.
Side Note: There may also be some complexities with the term “out of pocket” which you should talk to your insurance company or provider about. In order to discover how out of pocket elements may affect your particular situation.
Because of the complexities of this, it can be important to contact your insurance company to get a clear picture of how your specific policy works and what it will cover related to both in network and out of network physical therapy. Most of the best physical therapy clinics are well versed in the subject and some (like ours) will check your insurance benefits for you. In order to understand what possible partial or full payments may be required of you during treatment. So when you think you have answered the question “can I afford the best physical therapy near me” don’t be afraid to ask the physical therapy clinic if they can check your insurance benefits for you.
Looking at the benefits of In Network vs. Out of Network physical therapists
Weighing the benefits of each may be important to consider when answering your question of how can I find physical therapists near me for me. After all, your goal is to truly get better right? The benefits of in network PT are clear. You pay less out of pocket… And sometimes you pay almost nothing out of pocket for your treatments. So if you are injured and really strapped for cash, some physical therapy is better than no physical therapy… Thus In Network providers may be the best option for you.
However, based on what most insurances pay to their in network physical therapy providers. The in network physical therapists usually try to pack in as many patients as possible per hour to help with profits. What this means, for most, is patient’s at in network physical therapy clinics usually only spend a small portion of their treatment time with an actual physical therapist. The rest of the time is spent on machines, ice, with assistants, etc. Also in network physical therapists are only allowed to do certain types of treatments that are acceptable as reimbursement by insurance. (Similar to MD Doctors being limited to only being allowed to do certain types of procedures approved by insurance companies) So an in network physical therapist may be limited to less progressive types of healing treatments to provide the patient with in network.
On the other hand there are several benefits to out of network physical therapy. Of course the down side is that you do have to pay out of pocket, depending on your out of network benefits. But for many, the enhanced healing benefits outweigh the cost, especially if you are dealing with a more complex or long-term injury. When answering your question how can I find expert physical therapy near me. The dedicated focus of an out of network physical therapist may be what is needed to solidify and strengthen your road to recovery. The best out of network physical therapists offer full one-hour treatment sessions where all of your time is spent directly with an expert Doctor of Physical Therapy. This means they can focus on enacting the most beneficial treatments for you. And take their time to ensure that the treatment is not rushed. After all, you are there for physical therapy so why not spend all your time with the physical therapist? In addition out of network physical therapists are able to use any type of advanced healing method they think will be best for your situation. They are not bound by an insurance company’s rules for reimbursement as to the methods that can be used. This allows them to offer more progressive methods that may bring your body into better balance accelerate the healing process.
I know altogether this is a lot to absorb in order to find your answer to how can I find the best physical therapy near me. However I believe that if you follow the guidance offered within this blog. You can have a much better chance of finding a great physical therapist near you who is just the right fit.
Sincerely, Dr. Carr
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Dr. Erin Carr is owner and head practitioner of Dr. Carr Integrative Physical Therapy. She has been featured in Malibu Times Magazine as a “Local Specialist”. Dr. Carr Integrative Physical Therapy’s therapists offer in office visits from our clinic in Santa Monica. As well as off site home physical therapy for patients throughout many areas of Los Angeles, CA.