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Do you know your health care benefits?
In July, Highmark BC/BS relieved its members of the need to obtain referrals from specialists and the like. In October, Physical Therapists became eligible to deliver Direct Access care, meaning that a client can now receive physical therapy services without a prescription or referral from a physician. “Direct Access” put physical therapists on the same playing field with chiropractors when it comes to treating acute and chronic neck and back pain. Most people seek the help and expertise of a chiropractor when their necks are hurting, they have headaches or their back “just went out”. I am now here to educate you on the fact that you can receive relief from physical therapy for the same ailments and more. The general understanding of Physical Therapy seems to be that a person would receive therapy after an accident, surgery or severely limiting injury. Because of the vast training that is received by physical therapists, these more severe injuries can be treated, as well as general aches and pains, poor posture, headaches, decreased strength and range of motion, debility due to chronic disease (fibromyalgia, chronic fatigue, rheumatoid arthritis, osteoarthritis) and debility due to obesity. Physical therapists have been the experts at delivering hands on care with the use of “therapeutic modalities” and “therapeutic exercise”.
What is a therapeutic modality? It is an agent that will cause a physical change in a body tissue or cell to achieve a result. Modalities utilized at Balance For Wellness are heat, ice, electrical stimulation, ultrasound and infrared sauna, along with manual therapy techniques (hands on care). “Therapeutic exercise” is exercise that is prescribed to enhance strength, range of motion, functional ability and general endurance, while decreasing the possibility of injury. Therapeutic exercises used at Balance For Wellness include therapy ball, yoga, theraband, weights, stretching and others that have been proven to decrease symptoms and improve general mobility.
THIS is where it becomes crucial for you to understand your health care benefit.
Highmark Blue Cross/Blue Shield has changed the term “physical therapy” to “physical medicine”. They changed this term to continue to allow health care practitioners, other than physical therapists, to bill for the above mentioned modalities and exercises. Highmark has stated that physical therapists, chiropractors, doctors of osteopathic medicine, doctors of medicine and others can bill your insurance thru the “physical medicine” benefit.
You need to be aware that as any one of the above begin to bill for “physical medicine” services, your benefit will decrease so that when you are in need of “physical therapy”, your benefit may be exhausted. You must be educated on what this benefit entails in order to receive the benefits that you are paying for. If you have a “physical medicine benefit” that states “20 visits per year” with a $10 or $20 co-pay per visit and you visit a chiropractor 15 times or 20 times, you will no longer have benefits available for physical therapy. Realize that the above-mentioned practitioners, other than physical therapists, have separate benefits to cover their office visits and techniques utilized for necessary care. When you visit one of these practitioners and they bill for their service of expertise plus “physical medicine”, two of your available benefits are utilized decreasing your physical therapy benefit by one. Physical therapists will bill for “physical medicine” benefits only and not exhaust your other health care benefits.Be aware of your benefits (Medicare, BC/BS, and other third party payers). If you are not, read your contract, call your insurance company and talk with your health care practitioner to be aware of what your insurance is being billed.
Consult with Balance For Wellness Physical Therapy to determine the most beneficial course of treatment for you.
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