At Bodylogic, as a courtesy, we will bill insurance that we are affiliated with because we want to be sure that finances do not limit access to good care. Unfortunately, working under the limits of Insurance companies can be a bit frustrating, controlling and cause us all to jump through hoops. Here are some of the hoops:
- REFERRALS: Many (most) insurance companies require a referral for therapy. MEDICARE in particular requires a referral from your MD and it needs to be dated on or prior to the date of initial evaluation. BLUE CROSS BLUE SHIELD does not require a referral.
- INSURANCE LIMITS: There are limits regarding the use of insurance. Insurance is NOT intended to be used for wellness, massage, personal training ——feel good therapy or fitness. To use your insurance, there must to be a starting point and an ending point and there needs to be progress in order for it to be covered. The typical wording from insurance companies is that the treatment needs to be MEDICALLY NECESSARY. Although, continuation of care may be beneficial and preventative, Insurance can not be used for skilled therapy that is not considered medically necessary
- HOW WE MANAGE INSURANCE: We open your case, offer approximately 6 weeks of therapy at a frequency of 1-2 visit per week. Then we do a re-evaluation; and if there is clear progress and you have not reached set goals, you may be eligible for another round of therapy. Keep in mind that there are exceptions. Some of those include certain surgeries that come with specific protocols prescribed my MDs.
- OVER UTILIZATION: If a therapy clinic over utilizes insurance beyond what is considered medically necessary, or if they feel that a patient has reached maximum therapeutic benefit, we can be penalized with lower reimbursement in the future, and may have to pay back money paid to us for your treatment.
- INSURANCE FRAUD?: If you have a prescription/referral for therapy to address your neck, we can not treat your foot. Having said this, the body is a functioning whole and we look at the entire organism for impairments and connections. It is a tricky balance, but we need to follow the rules, not doing so constitutes insurance fraud.
- VISIT LIMITS: Please understand that often insurance companies only offer you a certain number of visits within a year, so it may be important to conserve some of those for other issues or same issues that may present later in the year. Regarding Medicare; there are caps that are placed on your care. When you reach a certain amount of money spent, we have to change the way we bill. Further limits will put a ‘red flag’ on your case which will cause a potential audit and the possibility of needing to pay Medicare back for services rendered.
If You Choose To Self Pay For Your Care
None of the rules above will apply. You and your therapist will come up with a strategy for the absolute best outcome.
