Do you have an injury and need occupational therapy or physical therapy services but not sure what you are covered for? Insurance is a quagmire that I would rather not even deal with but it very much is a huge aspect of healthcare. I know because I also deal with it on my end as a consumer not just from a business stand point. It’s not fun but I am going to break it down for you as it pertains to physical and occupational therapy.
If you have a commercial insurance plan, you need to know about:
- in-network benefits
- out of network benefits
- deductible for both
- co-pays or co-insurance
Most people know from a primary care stand point how much it cost to see your doctor or specialist. Insurances are great for that, covering for when you are well and just need check-ups. Also great if you are really sick and need more intensive care such as hospital stays. All costs are on the rise but when you go for check-ups, it is once in a while. When it’s an emergency, of course you will pay for whatever you need to save your life. Hopefully that is not happing all the time! Everything else is in the middle. And that is where therapy is. Occupational therapy and physical therapy is that service that falls in the middle in my humble observation.
No one knows what their therapy benefits are until they get hurt and need it. I know I didn’t know until I got hurt and needed therapy. Therapy visits can be several times a week for weeks or months. It can be financially taxing if you have co-pays, co-insurance, limited visits, and limited locations that you can chose from. Most people think they pay too much for insurance already, why isn’t it covered more? It just isn’t…and why is a whole other blog…
Insurance plans are NOT all created equal no matter how much you pay. Some have limited number of visits, some require authorization regardless of the fact that you have coverage. Co-pays vary widely.
Pros of using in-network – low co-pays – and that’s relatively speaking. But you may be limited on where you can go for your therapy and quality of therapy services.
Pros of using out of network – you have more options of where, what specialist you are looking for, and the quality of services (meaning more one on one care). But be prepared to pay a little bit more per visit.
Medicare and Medicaid insurances have really changed as well. If you have straight Medicare or Medicaid, then you just need to find those clinics that take that insurance (most do). That’s the easiest scenario. Medicare has a $1,960 limit for OT, and PT and SLP services for the year. Medicaid services only cover occupational therapy for minors (under 21) and physical and speech therapy for all ages. But if you have a commercial insurance Medicare or Medicaid, you have to check with those insurances what is actually covered and where you are allowed to go, because that’s who controls your contract. Those plans have limited therapy clinics that you can go to if you want to be covered for your therapy services.
Who are we in-network with?
- Plain Medicare
- Plain Medicaid for minors only
- United Health Care – but our disclaimer is we are not in-network with all the different umbrella companies that belong to UHC
- Various worker’ compensation companies
- Self-pay
Hand on Therapy Services is mostly out of network with insurance companies. We help where we can due to the fact that we cannot seem to get in-network with most of the major insurance companies. We offer very competitive self-pay packages along with quality therapy services making sure to limit the number of patients at any one time. As the occupational therapist and certified hand therapist, we specialize in all types of shoulder, elbow, wrist, and hand injures. There are not many certified hand therapist in Miami, much less in the Doral/Miami Springs area. We make sure based on the evaluation, we recommend appropriately how many sessions you may need based on the injury and of course what you are able to financially cover. An extensive home exercise program is developed for you and the more you are able to do it, the less you need therapy! Don’t worry if your prescription is more frequent, we will still only recommend based on your need. But more times than not, if you don’t, we will recommend that you don’t need so much hand therapy. In some cases, coming out of network can save you so much money and time in the long run. After all, we just want you to get better as fast as possible!
Do you need hand therapy but not sure what your insurance covers? Click here to give us a call and we can help!
Thank you!
Disclaimer: As with all our pages, this is NOT a substitute for formal medical treatment or occupational therapy. It is intended to inform only. Hands on Therapy Services disclaims any liability for the decisions you make based on this information.
Hands on Therapy Services in Miami is one of the best hand therapy and occupational therapy clinics in the Miami area. Hands on Therapy Services is centrally located by the Miami International Airport, For more contact info please click here or call us at (786) 615-9879.
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