- What is out-patient physical therapy?
- Who are physical therapists?
- With which insurance companies does Maven participate?
- What are the educated and experiential backgrounds of licensed physical therapists (the DPT)?
- How do I know if my physical therapist is a qualified professional?
- Who is the governing body for the physical therapy profession?
- What are some obstacles of being a private practice in New Jersey?
- Back pain questions
- Shoulder pain questions
- Prior to Initial Appointment
- I’ve never been treated by a PT. What should I expect during my first visit?
- What do I need to do before making an appointment with a Maven Physical Therapy?
- Do I need a physicians’ prescription to receive physical therapy services?
- How can I make an appointment and what information is required from me?
- I don’t have insurance. What are my options at Maven PT?
Out-patient physical therapy is a broad term for individualized physical therapy care that is rendered in a private practice or hospital setting. Patients seen in this type of setting have physical disability, functional limitations, or impairments as a result of a recent injury, neurological disease or condition, (corrective) surgical procedure, or musculoskeletal pain. Patients are usually cleared medically before seeking our care. However, all physical therapists are trained to screen for general medical conditions.back to top
Physical therapists are licensed, health care professionals who treat patients with musculoskeletal or neurological injuries and cardiopulmonary conditions. Therapists approach patients with the mindset of restoring functional strength and range of motion, decreasing or managing pain, and helping patients return to their activities of daily living, which may include recreational or competitive sports, fitness, gardening, or work-related activities to name a few.back to top
We participate as an out-of-network provider for most insurance companies including Horizon BC/BS, Oxford, United HealthCare, Cigna, and others. Patients are responsible for all deductibles, coinsurances, and co-pay amounts under their legal agreement with the terms of their insurance companies.back to top
Doctors of physical therapy are required to attend seven years of education (six years for combined college/graduate programs), that is:
- four years of undergraduate studies in the basic sciences and humanities
- three years of rigorous graduate education specifically in the field of physical therapy
Physical therapy education emphasizes the application of functional anatomy, kinesiology (biomechanics), pathology, and exercise physiology for evaluation, treatment, and injury preventionback to top
Aside from your past experiences, word of mouth, or referral from physician, it may be difficult to tell whether or not your physical therapist is a qualified professional. However, do consider the following when choosing a therapist:
- License to Heal
As with all medical professionals, physical therapists are required to be licensed. If you reside in NJ, make sure your therapist is licensed in NJ
The education of a physical therapist is extensive and now includes the entry-level doctorate education. Make sure that your therapist is a graduate of an accredited physical therapy graduate program and an active member of the APTA, our professional governing body. A therapist who is a member of the APTA is committed to making ethical decisions about services rendered to you and to providing you with quality clinical care.
Autonomy or Chicanery?
Physical therapists are autonomous practitioners. Our state practice act and extensive clinical training allows us to treat patients without the direction of a physician to implement care that is within our scope of practice ( http://fsbpt.org/ ). If your therapist is working under a non-physical therapist, what does that say about your therapist? Seek care elsewhere! Deceptive billing practices occur when a therapist’s services are billed by non-physical therapy providers. Remember, it’s YOUR copay!
Up-to-Date or Out-of-Date?
Ask your therapist if they have attended any continuing education courses in the past year or two. An ethical practitioner is always looking to learn the most current, evidence-based methods of treatment in their particular specialty or area of interest.
The American Physical Therapy Association is our governing body. The APTA is our profession’s greatest advocate for supporting policies and laws that pertain directly to our scope of practice.back to top
Why does Maven Physical Therapy choose to be an out-of-network provider for most insurance companies?
As mentioned, insurance companies have been making it progressively more difficult for providers and consumers by lowering reimbursements and increasing premiums, respectively. Some of the insurance companies have even placed a cap on the amount of reimbursement per session REGARDLESS of the services you may receive.
For example, let's say you have a torn ACL and recently had reconstructive surgery for it. For post-op rehab, you decide to choose between clinic A and B because they are on your insurance plan. Your insurance company (HMO) reimburses physical therapy at a flat rate of $50 per session, but the difference in service may be significant:
Do you see how the quality of your care is directly affected? Have you noticed how crowded physicians' offices have become? How about the amount of time you spend on average with a physical therapist? Many of our competitors rely on high patient volume (more patients scheduled per hour) to make up for the decreasing reimbursements they receive from insurance companies.
Meanwhile, your copay, deductible, or monthly premium may increase has already increased. Insurance companies have also been placing more restrictions on your access to deserved care; you may not realize that your physical therapy benefits may have preset conditions, such as the following:
- "30 days of physical therapy per condition, per LIFETIME"
Translation- if you ever have the same problem at any point in the future, you will not be covered.
- "20 visits of physical therapy a year"
Translation- if you require more than 20 visits for a given diagnosis (as is needed for certain types of post-op rehab), you will not be covered.
- "Requires a physician referral and authorization from your insurance company"
Translation- not only must you go to your physician and pay a ?$20 co-pay, after the physical therapy evaluation is completed, you must wait for further "approval" from your insurance company...sometimes up to a week before you can schedule a needed follow-up appointment.
You would agree that this is not very favorable to you if you're in a lot of pain.
While several insurance providers do provide fair reimbursement and excellent coverage for patients, others do not. Fortunately, many insurance providers do allow for what is known as "out-of-network" medical benefits. Out-of-network simply implies that your medical provider does not participate with your insurance company's "in-network" plan and that your care will be covered, but with a little more responsibility on your end. What does this mean for you?
With out-of-network plans, you will be able to spend more one-on-one time with your medical provider and access our highly skilled care, since we can keep our patient volume at a more reasonable level.
As a result:
- You may require fewer visits for your plan of care
- You will have very specialized care
- You will be able to choose Maven Physical Therapy even if we are not in your insurance provider book
- You may have a little more out-of-pocket responsibility for the short-term, but as a result, in the long term
- You may require fewer visits for your plan of care
- You will have very specialized care
- You will be able to choose Maven Physical Therapy even if we are not in your insurance provider's book
Is it still a wonder to you as to why many medical providers, these days, are going out-of network with insurance plans? Maven will be participating with Medicare and several in-network plans, but we will also be out-of-network providers for many other plans.
Please feel free to contact us at 201-977-4441 if you need to discuss any insurance questions further.
As with any business, competition can be fierce. Private physical therapy practices are no different in this regard. We compete largely with physician or chiropractic-owned practices and corporate rehabilitation companies - Kessler, HealthSouth, Hudson, Novacare, e.g.).
Another obstacle that every practice faces is the insurance company. Insurance companies cause rifts between the provider-patient relationship by making it difficult for you (by increasing your premiums and lessening your freedom to choose who YOU want to see) and for us (by decreasing our reimbursements).
Meanwhile, the CEO of your insurance company is making out OK. Don’t take our word for it, read this:
- United Health Care’s executive salary: William W. McGuire: $59.6 mil (2005)
- Aetna’s Executive salary: John W Rowe Total Compensation: $22.2 mil (2005)
- Aetna’s NEW Executive salary: Ronald A Williams $30.86 mil
In its efforts to dampen the rising costs of care, Medicare (now, the National Government Services) has also been making it more difficult for patients to access physical therapy care by putting restrictions into place, such as the Therapy Cap, which allows eligible Medicare patients to receive a whopping10-12 visits PER YEAR. What does this mean for you? Let’s just say you were rehabilitated for an ankle sprain and used 10 visits, then later that same year, broke your wrist in a fall and needed rehab to help you return to your activities of daily living. What will be your options at that point? Your secondary insurance will only be paying a portion of what Medicare pays, so if your Medicare benefits are up, your secondary insurance WILL NOT cover the remainder. You need to take this to heart and do something about it. Call your senators and house representatives! These are your entitled benefits!back to top
Prior to Initial Appointment
Your first visit will be an educational experience. Hopefully, you will be left with a good impression about what we do and how diagnose and decide on treatment. You will be asked to fill out a few forms, including a medical questionnaire, which should detail items such as your past medical history (surgeries, injuries, diseases, etc.), medications, diagnostic tests, to name a few. You will also be asked to provide us with your medical insurance card(s).
During our first visit, we will be spending a great deal of time listening to you. More times than not, an experienced clinician will be able to hone in on what is causing your symptoms and how to treat not only the symptoms, but the underlying source. We will then perform a battery of examination techniques to verify our hypotheses (or clinical "hunches"), and then inform you of our findings and plan of care.back to top
We encourage you to contact your insurance company and verify your insurance benefits for physical therapy. It is for your own protection that you do this any time you seek medical care so that you are not held liable to pay a huge bill for services that you were unaware of that wouldn’t be covered and also to protect yourself against fraudulent billing practices.
As a web-friendly physical therapy practice, we strongly encourage you to first register on-line and fill out Maven’s forms prior to the first visit. Upon completion of these forms, we will be able to keep track of your file for all of your future appointments. This will enable us to save a lot of time and make your experience with us that much more efficient.back to top
In the state of New Jersey, physical therapists are able to evaluate and treat patients without a prescription as long as the care rendered is within their scope of practice. Direct Access legislation that was passed in 2004 has changed the way physical therapists practice. Our education and clinical training enable us to treat musculoskeletal and neurological conditions that do not require medical attention. We are also trained to effectively screen and refer patients who have conditions that do warrant further and sometimes immediate evaluation by a physician. With the exception of workers’ compensation or no-fault cases, and Medicare, the major medical insurance companies will pay for services rendered without a physician’s prescription.back to top
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Maven does its best to accommodate its patients. We do provide you with the option of private pay (cash, personal check, credit card).back to top
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