Understanding Health Insurance!

Insurance… Know before you go!

 
Health insurance is not only a hot button topic for most but can be extremely complicated. People may have difficulty knowing what services are covered, by whom they are covered, what office you can be seen at, and how much you might owe post visit. Most think and feel that since we may pay high premiums that all services thereafter should be covered 100% by the insurance company. Unfortunately, this is not true depending on the insurance plan you have signed up for. The best way to find out all the information is to contact your insurance provider prior to any medical visit to determine what your cost may be. At North County Water and Sports Therapy Center we take the extra step, before scheduling you for appointments, to verify your benefits and confirm what attending therapy might cost you. Insurance coverage explanation involves verbiage that you may not completely understand. Below is a list of terms you may encounter when speaking with your insurance company or our staff at the front desk that will help you understand your insurance benefits.

 
Deductible: A fixed dollar amount, usually a calendar year that the insured has to pay in full before the insurance company will pay for services. Plans may have individual and family deductibles.

Copayment (copay): A fixed dollar amount that the insured pays at time of medical services received. This amount may differ between your primary care providers versus a specialist, such as Physical Therapy. Some plans may require you to meet your deductible first before the copay applies.

Coinsurance: Requires the insured to pay a percentage of medical expenses after the deductible amount, if any, is paid.

Out of pocket max: A fixed dollar amount that the insured is required to pay each year out of his own pocket that does not include premiums, and depending on your insurance can be different for an individual versus a family.

Preauthorization: When an insurance company requires documentation prior to your first visit or after your first visit to determine medical necessity for treatment and visit allowance for episode of care.

Visit limitation: Some insurance companies put a limit of the number of visits a patient can have each year regardless of injury type or occurrences throughout the year.

Visit review: Some insurance companies allow you to have a certain number of visits, and after that number is reached they require a review of your case. In some cases they may deny any further treatment.

This is just a short list of terms that you may come across when deciphering your benefits for therapy. When you contact our office for an appointment we will do our best to answer any questions you may have regarding your insurance as it pertains to Physical Therapy.

Are you in need of physical therapy?

Are you in need of physical therapy? Below are some FAQs to help you in the process.

Why choose North County Water and Sports Therapy Center?
We are a privately owned clinic, and our goal is to focus on individualized care. When you attend therapy here you will have one-on-one time with a physical therapist or physical therapist assistant for the entire treatment. We also incorporate aquatic therapy where appropriate to supplement a land based program. We pride ourselves on being the best, but do not take our word for it, CHECK OUT the online reviews and see first-hand how people feel about our clinic.

Will my therapist be licensed?
All the Physical Therapist at NCWSTC are licensed as Doctor’s in Physical Therapy, and we also have one licensed Physical Therapist Assistant. We do no utilize unlicensed aids or ancillary staff to treat our patients.

Will I work with the same therapist each time?
We strive to keep you with your original therapist or our one physical therapist assistant for each session. We work closely with our assistant to assure you are getting the best care each time you attend a session of therapy.

What insurances do you take?
We are contracted with most PPO plans as well as Medicare and Tricare.

Do I need to see my Doctor first before starting therapy?
As Physical Therapists in California we have Direct Access, which means you can attend therapy for 12 visits or 45 days without a prescription from your physician. Some insurance companies require that you see your Doctor and get a prescription before attending therapy, so if you are unsure, please contact the front office and we will verify your insurance and find out the next steps.

Can I choose where I go to therapy?
Some physicians will recommend physical therapy offices that they have worked with in the past, but if we are contracted with your insurance, you can choose to come to our facility.

What happens once I am done with therapy?
At the end of your formal course of therapy, you will be set up with a comprehensive home exercise program to maintain the goals you have made in therapy.

What is the most frequent injury you treat?
We see patients with all different types of injuries or pain symptoms, but most commonly we see low back, neck, shoulder, and knee pain as well as patients’ that need therapy post operation.

How do I schedule an appointment?
Call the office directly and speak with our front office staff at 858-675-1133
If you have any other questions please visit our website at www.waterpt.com or call the office at 858-675-1133. We are happy to help!