Q: What can I expect to pay for my Physical Therapy?
A: Payment for your physical therapy is based on your insurance provider as well as the specific plan you have with that company which determines your deductible or co-pay amounts as well as your co-insurance coverage. This is based upon the contract that your employer has set up with the insurance carrier. Each insurance company differs in what is called an Allowable Fee Schedule, which is what the company is willing to pay for the services provided at physical therapy. You, as the insured party, are subject to payment of the services provided in PT based on your insurance’s Allowable Fee Schedule. If you have a deductible, you will be responsible for paying for services “out of pocket” up to that amount before your insurance will begin to pay, or help pay as it is, for your physical therapy services. Once the deductible is met you will be responsible for a percentage of the total cost of your physical therapy. If you have co-pay, you do not have a deductible to meet but you will be responsible for a fee at each visit which is also different between insurance companies and can also be variable between plans within the same carrier.
At Revolution, we work with your insurance company on your initial visit to both verify and clearly define what your coverage is as well as what your payment responsibilities. One of our friendly staff members will have this information ASAP so all parties involved are aware of what your payment responsibilities will be.
Q: What is a co-pay?
A: A co-pay is a set amount of money that you agree to pay at each visit. This number is set by your insurance company and is based upon the specific plan you or your employer have chosen. In your insurance contract, if you have a co-pay, you have agreed to pay this amount of money for each session of physical therapy. Not all co-pays are the same and Revolution does not set the price of your co-pay.
Q: What is a deductible?
A: A deductible is the amount of money that the insured is required to pay for services provided before insurance will begin to pay. This is a set number by your insurance company that is specific to your plan. Once your deductible is met, your insurance company will then begin to pay for a percentage of your physical therapy care and you, the patient, will be responsible for the remainder of the cost.
Q: What is Co-insurance?
A: Co-insurance is the percentage of what your insurance company agrees to pay for your physical therapy care based on your specific plan. For example, Medicare patients have a $180.00 deductible to cover before co-insurance “kicks in”. After the deductible is met Medicare pays 80% of the cost of physical therapy and you, the patient are responsible for the remaining 20%. That remaining balance can either be paid for “out of pocket” or with secondary insurance.
Q: What is secondary insurance?
A: Secondary insurance is coverage by a second insurance company, mostly seen with Medicare, which is purchased by patients for coverage of the 20% that Medicare does not cover in the Medicare Co-insurance structure.
Q: Why does my bill vary?
A: Physical therapy is generally covered by insurance on a “fee for service” basis. This means that depending on what your therapist deems as appropriate treatments for your specific injury or problem you will have an individualized treatment plan which is specific for you. Based on services rendered in a visit, or not rendered, your insurance will be billed differently but specific for each visit. Your bill may then vary due to the differences in what your co-insurance ratio may be.
Q: What can I expect to pay for PT as a Medicare patient?
A: Medicare patients are responsible for a $147.00 deductible at the beginning of physical therapy care. Once the deductible has been met, Medicare will pay for 80% of the total cost of all services rendered and the insured individual is responsible for the other 20%.
Q: Will my secondary or supplemental insurance help pay for the costs not paid for by Medicare?
A: Most often, your secondary or supplemental insurance will cover the cost which Medicare did not pay.
Q: How much will Medicare pay for physical therapy?
A: For the year 2013, Medicare will pay up to $1,900.00 for physical therapy care.
Q: What happens after I meet my $1,900.00 Medicare therapy cap?
A: As long as improvements continue to be made and your therapist continues to document your appropriateness for physical therapy, your coverage can generally extend to $3500.00.
Q: How can I pay for the amounts that I am responsible for?
A: Each month, you will receive an invoice from the clinic with the amount that you need to pay, which your insurance did not cover. You can pay by phone, mail, or in person, by check credit/debit card or cash.
At Revolution we understand that health care payments are variable and usually not worked into a budget which is why we can set up individualized payment plans for your convenience. Please call for specific information regarding your payment plan.
Q: Does Revolution accept my insurance?
A: We are in-network for the majority of major insurance carriers and provide “out of network” coverage for those insurance companies of which we are not “in network”. Please call for more information about coverage with your specific insurance provider.
Q: What is insurance authorization and how does that affect my physical therapy care?
A: Some insurance companies and plans require pre-authorization for physical therapy services. With the authorization the insured will be allotted a set amount of visits based upon the condition for which you are being seen. After these visits have been used, our office staff and Physical Therapists will begin to advocate for you to your insurance provider, based on your individual status and plan of care.
At Revolution, we feel it is our responsibility to you, as our patient, to aide in the insurance process to allow you to continue to have access to our services. Also, we feel it should be a collaborated effort between you, the patient, and your physical therapist as to when your physical therapy is completed and you are back to a high level of function.
Q: What if I don’t have insurance?
A: For those that are currently uninsured, we have a self-pay plan in which you can enroll. For more information about the self-pay plan please call our office.
Q: Will my insurance cover my physical therapy care if I’m being seen through direct access?
A: Yes. In Pennsylvania, qualified physical therapists are able to see patients without a referral from a physician. Insurance will cover your visit(s) based upon your benefit schedule for physical therapy the same as if you had a prescription from a physician. At Revolution, we are a direct access clinic, but not all outpatient physical therapy clinics offer this service.
What is Metabolic RX Therapy?
We will also be the first in the Pittsburgh area to offer a comprehensive program, Healthy Lifestyle and Weight Loss program which targets the many people of our community with chronic diseases and those who are in the early pre-stages of development of chronic diseases. Their currently exists no program and facility that provides medically supervised exercise and nutrition programs for those with chronic diseases such as high blood pressure, metabolic syndrome, and type II diabetes. The wellness clients will have the option to participate in a wide variety of specifically designed programs tailored by the results of the screening. Wellness screening will entail: blood pressure, percent blood oxygen, heart rate, hydration status, basal metabolic rate, nutritional analysis, full body physical therapy evaluation, video software biomechanical analysis, body composition, sports specific conditioning. Patients will then undertake in a year round comprehensive program to improve their nutritional status and physical fitness.
What is a modality? Modalities are technologies in used in Physical Therapy to help speed up the recovery process following injuries, surgeries and mechanical repetitive stress musculoskeletal pain. For more information See Modalities page.
What is Therapeutic Exercise?
AKA Ther Ex, it is a type of physical therapy intervention that is prescribed to improve or restore human movement. Limitations in normal movement. i.e. strength, range of motion and flexibility of joints, and/or cardiopulmonary endurance are often accompanying symptoms following an injury, surgery or mechanical repetitive stress musculoskeletal pain. We assess the patient to determine specifically what limitations they are experiencing. After the evaluation, Ther Ex is prescribed to improve these limitations. The difficulty of Ther Ex is progressed based upon the capacity of the individual to perform the exercise. Everyone has physical limitations, or imperfections and everyone should be incorporating Ther Ex into their exercise routines as a preventative measure.
What is Neuromuscular Re-Education?
This is a therapeutic technique through which the neuromuscular system is specifically targeted. The essential areas are; balance, coordination, proprioception and kinesthesia. These are all vital pieces for normal and optimal human functioning but are also all intuitive senses that can be effected by disease or dysfunction and enhanced through proper training. Training could include activities such as one-legged exercise to closing eyes while maintaining a specific posture.
What is Manual Therapy?
Manual Therapy is an umbrella term for hands on therapeutic techniques employed by physical therapists to improve ROM, joint mobility, soft tissue quality, strength and function. There are many different types of manual therapies and philosophies. that aims to manipulate the structure or function of the human body by specifically directing forces to increase whatever the deficit may be. The idea is that the PT will be able to put the patient’s body into positions with forces applied that the patient could not reproduce alone. These techniques could include stretching and mobilization of hypomobile joints and soft tissue or stabilization activities for unstable, hypermobile joints.
What is Direct Access?
Direct access to Physical Therapy is the opportunity to be evaluated and treated by a licensed Physical Therapist without a referral from another health practitioner. Direct access is your opportunity to save time and money by expediting your treatment, relief, and recovery. Thirty-eight states, including PA, have granted consumers the freedom to seek Physical Therapy treatment without a referral. Referral by physicians causes delays in the provision of Physical Therapists’ services to individuals who would benefit from treatment by a Physical Therapist. Delays in care result in higher costs, decreased functional outcomes, and frustration to patients seeking Physical Therapy treatment. Elimination of the referral mandate results in timely, and thus more effective, Physical Therapists’ services.
What is Physical Therapy?
Physical Therapy, according to Department of Labor job descriptions, is a profession that provides services that “help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or disease.” Physical Therapists help to restore, maintain, and promote overall fitness and health. Their patients include accident victims and individuals with disabling conditions such as low back pain, arthritis, ligament sprains, tendon injuries, and muscle injuries.
What do we think Physical Therapists are?
Physical therapists are the practitioners of choice for integrated musculoskeletal performance enhancement. Physical therapists are able to properly assess movement disorders that often contribute to musculoskeletal injuries or that occur following the aforementioned injuries. People now have direct access to a physical therapist’s unique body of knowledge with the legislation change that occurred in 2004.
The physical therapists employed by Revolution Physical Therapy have been certified for direct access through the
state board of physical therapy, which allows a physical therapist to treat patients without a referral from a physician for up to one month. Every patient receives medical screening and a physical therapy differential diagnosis. Each patient’s primary care physician will be contacted by our physical therapists to determine the treatment plan.
Currently direct access is not being employed by many of the practitioners who have been practicing in the traditional model for many years. This occurs partially from complacency and partially from fear of retribution of the physicians. Direct access physical therapy is a great avenue to create relationships with physicians. Proper communication and documentation allow the physical therapist to demonstrate their unique body of knowledge and their authority as the practitioner of choice for assessment and conservative treatment of movement related musculoskeletal pathology.
What is Movement Improvement?
Movement impairments are symptoms that often precede and follow musculoskeletal related pain. There are many signs and symptoms related to musculoskeletal pain. Pain is typically the last symptom a patient recognizes. Prior to experiencing pain a person frequently has a movement impairment. Sometimes it is low intensity and magnitude such as repetitive movements like jogging with abnormal bony alignment, limited flexibility or lack of adequate muscle strength that leads to problems such as tendinitis. Movement impairments can also be classified as high intensity and magnitude such as a dislocated joint and a subsequent ligament rupture. People who sustain injuries will also frequently develop secondary movement impairments such as limping (antalgic gait) to compensate and avoid pain. Also pain will most often be the first symptom to be relieved even without treatment. This phenomenon is what often leads people to return to activity too early and sustain a re-injury. Most people have movement impairments they do not recognize that are waiting to show up in the future as pain. Physical therapists can easily recognize and identify these impairments.
What is Physical Pain?
Physical Pain is an unpleasant sensory perception or experience that humans and animals identify in their conscious awareness. This occurs primarily when our bodies are trying to tell us that something we are doing or have done was harmful. Pain is a SIGNAL that something is wrong. Pain results from acute or chronic distress to a body tissue or system.
Experiencing a PAIN SIGNAL is like when the check engine light comes on in the car. The car’s system is trying to communicate to the driver that something is wrong. The driver then has the ability to respond appropriately. Very often we don’t recognize some of our own physical pains appropriately and therefore also don’t respond appropriately. Physical aches, joint and muscle pain, and distress such as nausea, fatigue, indigestion, heart burn, diarrhea, and malaise are included here.
A physical therapist is trained to identify pain and triage the patient to the correct healthcare practitioner. If you are having a non-emergent pain, set up an appointment with a physical therapist, preferably from Revolution. If you cannot reach a Revolution Physical Therapist from travel limitations please do not hesitate to set up a conference call to speak with a Revolution staff member.
Our Self-assessment can also be emailed to you or downloaded at www.revolutionphysicaltherapy.com/selfassessment. This self assessment can help you decide what to do in terms of physical pain you maybe experiencing. Emergent self assessment explanations on blog post or page created with lead ins to other parts of the self assessment – free portion – then lead in for pay portion
What is a Physical Problem?
A physical problem is any health care condition that requires diagnostic, therapeutic, or educational action. It is something that interferes with your normal daily tasks requires an alteration from your normal routine. IF you have a physical problem, a physical therapist may be able to help you become more efficient and effective with your daily routines. You don’t know what you don’t know. PT’s fulfill a primary roles a preventative specialist when people have surgeries as well as aches and pain. An effective PT program eliminates as many hazards, limitations and physical problems as possible in hopes to avoid an further damage of the healing body part or re-injury.
What is a Physical Impairment?
A physical impairment is any abnormality of a body part, organ, or system. This can either be temporary or permanent and may be caused by pathology or injury. Common physical impairments seen in physical therapy include pain, muscle weakness, and loss of range of motion. A physical impairment can be acute, chronic, benign and pathological. Physical impairments often result in significant pain and often accompany physical limitations. Some physical impairments may be silent and unobservable to the untrained eye. Most of these impairments can be improved upon. If the impairments are improved functional capacity typically also improves.
What is Physical Dysfunction?
Physical dysfunction is any abnormal functioning of tissue, organ or body part. This abnormal functioning causes us to have to significantly change our routines and often requires the use of an assistive device. Often leads us to disablement but is not necessarily considered disablement until capacity to perform acts and tasks expected in social roles.
Apprehension, fear, and avoidance are very common following an injury. This includes fear of re-injury that prevents a person from believing they are able to return to their normal exercise/sport or fulfilling their normal daily tasks. This is especially common in those who have experienced back pain.
What is a Physical Disablement?
Physical disablement usually occurs when a person is unable to perform actions, tasks, or activities that are expected in specific social roles. Examples of customary roles include self-care, home management, work, community involvement, and leisure.
What is difference between a DPT and PHD?
The DPT is a clinical doctorate which distinguishes a practitioner who has clinical skills at the doctorate level. The DPT is not a PhD. A PhD is an academic degree and primarily distinguishes a person to be an expert in their specific field and to teach at the University level.
What is difference between a Physical Therapist with a Masters in P.T. Vs. a Doctorate in P.T.?
Currently there is minimal difference between the DPT and MPT trained Physical Therapists. The DPT is very similar to the MPT, but the curriculum has been enhanced with more specific requirements to help distinguish Physical Therapy in the light of the APTA’s vision 2020 statement. The extra requirements are in the fields of radiology/imaging, differential diagnosis and medical screening, pharmacology, research, healthcare management, wellness and prevention, as well as histology/pathology which were not included in the traditional MPT curriculum.
Specialized Fitness FAQ
What is Specialized Fitness?
Specialized fitness is the umbrella term that encompasses all the services we provide in addition to physical therapy. Those services include Sports Training, Exercise & Wellness, Youth Conditioning, and our ACL/Injury Prevention program.
Do I learn about Nutrition in this program?
Nutritional advice will be given at the request of each athlete/participator. Although, it is not an official aspect of the training program.
What is difference between Young Conditioning and Sports Training?
Youth Conditioning is a less intense, class based exercise and conditioning program. Participants will still be given instruction on how to move correctly but in a more generalized setting. Sports Training is more specialized, more instructional, more personal (not to be confused with personal training), more intense, and assessment based. The athletes participating in the Sports Training will also have to participate in the Startup program and commit for 2 months. Youth Conditioning participants do not have to participate in the Start-up program and the program is not assessment based.
Is there a Discount to add family members to the program?
Yes. We offer a 25% discount for all family members or spouses that want to participate in any of the programs. Two or more family members do not have to participate in the same Specialized Fitness program to receive the discount. We also offer a 25% discount to associated teams. (Find out if your team is associated with us by emailing email@example.com). We offer discounts for referrals as well.
Can I just show up or do I have to have an Appointment?
You must schedule online (click here)
or with our front desk for every time you plan on coming in to work out. You can either do it in person or you can call and schedule over the phone. You can even schedule weeks in advance if you know what times you will be able to come in. This rule pertains to every Specialized Fitness program.
What If I go out of town? Do I lose the time or is the program flexible?
If you need to go out of town for an extended period of time, we will be happy to put your account on “hold” for a 2 week time period. Any time gone after that will be forfeited.
How do I know if this program is right for Me?
If you answer yes to any of the following questions, one of our programs is right for you:
Do you want to be a better athlete?
Do you want to feel better?
Do you want to have more energy?
Do you want to sleep better?
Do you want to look better?
Do you want to be able to exercise and not worry about getting hurt?
Do you want to lower your risk of injury?
Do you want to be able to move more freely and without pain?
Do you enjoy exercise?
Do you enjoy reaching your goals?
Do you want to perform at the most optimal level of functioning?
Will I have access to a Physical Therapist if I need to see one?
You will be able to meet and establish a relationship with each of our physical therapists. The entire program is overseen by our therapists and if for any reason you need to meet with one you will be able to.
Is this like a Gym Membership?
Our memberships are technically “gym” memberships but include much more than access to our facility. Even our most basic membership includes a comprehensive pre-program assessment and appropriate exercise program design. No one will walk through our doors without receiving those services and no one will exercise at our facility by “doing their own thing”.
Are there things I can do at home?
We will provide you with a home exercise program that includes corrective exercises for muscular imbalances and strength deficits along with cardiorespiratory exercise. The resistance training program we design for you will need to be done at our facility.
Can you just give me a program I can do at the Gym/Home?
We can provide you with a traditional weight training program for the gym or a specific home exercise program. You will still be required to go through the comprehensive evaluations. You can purchase both the program design and evaluation time for $200.
Is this Personal Training?
No. Our services are not personal training. They are semi-private training. Most of the responsibility of training hard will be on your shoulders. We will give you the tools to improve your performance, but you will be accountable for using those tools.
What is included in ACL/Injury Prevention Membership?
This membership includes a program that is designed specifically to target areas of weakness exhibited by the athlete that directly pertain to possible causes of ACL injury. The program is less intense and individualized than the Sports Training program but more specific than the Youth Conditioning.