Thank you for selecting Diamond Physical Therapy Associates for one-on-one physical therapy. Request an appointment online or call to schedule an appointment for your evaluation.
Once you have made your initial appointment, you can pre-register by clicking on the links for New Patient Forms below. Simply download, print, and complete the forms prior to your arrival. Doing so will make your first visit more efficient and allow us to spend more time focusing on you and your needs.
Upon request, you will receive a receipt with diagnostic codes, procedure codes, and Laura’s license number. This will provide the necessary information for reimbursement from your insurance company, Health Care Savings Account (HSA), and/or Flexible Spending Account (FSA).
Blue Cross Blue Shield (Indemnity Provider)
Laura will electronically bill Blue Cross Blue Shield as a courtesy to patients who have PPO insurance. BCBS will pay patients directly minus any deductibles and co-payments. If you have an out of state or “Blue Card” plan, BCBS may pay Laura and then Laura will reimburse you.
Commonwealth Indemnity Plan
Laura will electronically bill Commonwealth Indemnity Plan (the state insurance). Patients are responsible for contacting their plan and obtaining an authorization number. Laura will fax the initial evaluation to them and obtain authorization for visits. Patients are responsible for all calls to their insurance company in regards to payment
Laura does not accept Medicare. Patients cannot bill or be reimbursed by Medicare or your secondary insurance for her services. Laura’s services will be a “non-covered service” by Medicare. If you have a physician’s order for physical therapy and would like to utilize services through Medicare, you need to seek a Medicare certified provider.
HMO Benefit Exception
HMO insurance companies will not reimburse you unless you are able to obtain a benefit exception for a medical necessity. Some patients have been able to do this based upon medical necessity for aquatic physical therapy and the lack of any other specialized provider who practices in a therapeutic pool in their geographic area.
Important questions for you to ask your insurance company to help you understand your policy, benefits and reimbursement:
- Do I have out of network benefits?
- What is my deductible for these services?
- Have I met my deductible?
- What is my co-payment responsibility?
- Is your reimbursement calculated on the billable amount or reasonable and customary amounts?
- What is your reimbursement for an evaluation – codes 97161 (low complexity), 97162 (moderate complexity), or 97163 (high complexity) – all billed at $168.00?
- What is your reimbursement for 4 units of aquatic physical therapy – code 97113 billed at $42.00 per unit?
- What is your reimbursement for 4 units of therapeutic exercise – code 97530 billed at $42.00 per unit?
- What is the procedure for requesting a benefit exception based on medical necessity?
- Do you require pre-certification or pre-authorization prior to the initial evaluation and treatment?
It is recommended that you obtain the name of the person with whom you speak, their employee ID, and the date and time of the call. It’s also a good idea to escalate your questions to a supervisor level and follow-up with the same person every time.
Physical therapists know that the current insurance driven health care system leaves much to be desired. HMO reimbursement for physical therapy services is low. This business model necessitates that therapists at clinics that accept these insurance rates are often required to see 3-4 patients per hour and usually spend, on average, 15 minutes of one-on-one time with each patient and often aides or physical therapy assistants instruct patients in exercises.
During that time, the patient is often doing their home exercise programs in a crowded gym. Patients cannot communicate directly with their therapist by text, email or telephone. Finally, after the patient finally sees the therapist and agrees on a plan, the insurance policy will dictate the number of visits and reimbursement. Therapists and office staff spend a great deal of time interacting with the insurance company to received benefits for their patients.
I have chosen to focus on patient care instead of insurance billing. I would not be able to provide exceptional care and individualized treatment that you appreciate if I were working with an insurance-based model. At Diamond Physical Therapy Associates, you spend up to one hour with your therapist, and will likely require fewer visits to meet your goals. Your insurance company may reimburse you for part of the cost.
Your time is valuable and your health is paramount. What is your co-payment for physical therapy services and how many times a week is recommended by your physician? Consider using Laura as a consultant to help you achieve your goals faster and spend less money in the long run.
Joni had a total hip replacement. Hear what she has to say about why Laura is different than traditional physical therapists.