FAQ | Greenwood Pelvic Pain | Restore Your Core

FAQ

faq

Pricing and Insurance

All sessions at Restore Your Core PT are one-on-one with a Doctor of Physical Therapy who specializes in treating women and men with urinary and bowel dysfunction, complex pelvic pain cases, sexual dysfunction, low back pain, and prenatal and postpartum issues. The rates for evaluations and treatment sessions vary, so please call our office 1-317-559-2673 to inquire about pricing.

We are a fee-for-service practice and are not in-network with any insurance companies which allows us to provide a much higher quality of care delivered in less time.  We are considered an out-of-network provider. Receipts are provided to all clients who request them. The receipts include all necessary billing codes to allow our clients to send claims to their insurance companies.

***Please read below to gain a better understanding of why going out-of-network often makes it much cheaper to not use your in-network insurance benefits for some services, including PT, if you have a high deductible plan or high copays.

Why is insurance not billed at Restore Your Core Physical Therapy?

Unfortunately, insurance companies strongly suggest or dictate the length of therapy sessions and the types of treatments that patients can receive at in-network physical therapy clinics.  Restore Your Core is an out-of-network provider because we are dedicated to providing the very best care possible without compromising the high level of care we deliver. We believe in order to provide the very best care possible, our patients deserve full-length sessions to address both external and internal causes of dysfunction and pain.

Due to shrinking reimbursement rates and increasing pressure from insurance companies, the physical therapists at in-network clinics are forced to see 2-3 patients every 30-45 minutes.  Therapists are also forced to utilize therapy aides to assist patients with exercise and application of modalities, which increases the billable rate. A vast majority of the time, these clinics also require patients to be seen 2-3x per week.

We feel that hands-on treatment is much more effective than utilizing several modalities; furthermore, we do not believe in having patients complete exercises in the clinic that they can do on their own at home.  We do not employ therapy aides as we feel every patient deserves to receive one-on-one care from a Doctor of Physical Therapy. We typically see all new patients for a full 90-minute evaluation with 50-minutes follow up sessions.  The 50-minute long sessions, combined with one-on-one care, usually allows patients to be seen just once per week. This saves our patients time and money.

How can being seen at an out-of-network facility save you money?

The out-of-pocket expenses you incur at Restore Your Core are often less than what patients would pay at a clinic that bills and accepts their insurance.Due to increasing deductibles and copays, patients who pay out-of-network rates usually pay less than they would if they were in-network.

How is that possible??  

If you have a deductible to meet, you will most likely pay the full bill for each PT session until you reach your deductible (these bills can be $350-$700 per session depending on location).  However, you won’t receive those bills until you have been getting care for 6-8 weeks and have amassed an enormous balance. Unfortunately, even if you are paying $350-$700 per session at an in-network clinic, that does not mean your insurance company is applying the full amount toward your deductible.  Your insurance company typically only applies the amount that they deem as reasonable, which generally is far less than the amount you pay.

Our goal is to make you aware of the games the insurance companies play in order to pay as little as possible, thus maximizing their profits.  In order to weigh your PT options, it’s essential to:

  1.  Ask your insurance company what percentage of the total bill will be your responsibility to pay at an in-network physical therapy clinic, especially if you have a deductible to meet.  If you are responsible for the total bill until you reach your deductible, ask the in-network clinic what their typical charge is for a physical therapy evaluation and for a follow-up treatment session (not the agreed-upon insurance adjusted rate).
  2. If you have met your deductible, ask if you have a copay and the amount of the copay that will be due each session.
  3. Ask if you have an in-network deductible as well as an out-of-network deductible.  If you have two deductibles, then claims from Restore Your Core will not apply to your in-network deductible.

Now consider these things when deciding to go to an in-network clinic:

  1. Ask the in-network clinic how many times per week the average patient is seen.
  2. Ask if they utilize therapy aides/techs.
  3. Ask how many patients they see in one hour.
  4. Ask if you will see one physical therapist for your entire plan of care.
  5. Ask how much additional training the therapist has in the area of women’s and men’s pelvic health. Physical therapists do not learn the skills needed to treat pelvic and abdominal issues in physical therapy school.  It takes several years of continuing education to gain the necessary knowledge to provide patients with excellent quality care
  6. Ask if the therapist has a certification in pelvic health or if they are being mentored by a credentialed physical therapist in preparation to take the certification test.  Certification requires extensive testing. Therapists who have sat for the examination will have the designated credentials of PRPC or WCS if they have taken and passed a certification test.

Consider the quality of care you will be receiving at the in-network and out-of-network facilities.  What is the actual value of receiving one-on-one care from a Doctor of Physical Therapy versus that of an unskilled therapy aide/tech?  Take the time to consider how much time you will be spending away from your family or your job if the in-network clinic recommends seeing you 2-3x per week.  Also, consider the amount of time you will be seen each session. Taking into account all of the above-mentioned items will help you make an informed decision about where to receive your physical therapy treatment.

Can I submit my physical therapy receipts to my insurance company to obtain reimbursement for my out-of-pocket expenses?

Most non-Medicare patients can self-submit their therapy receipts to their insurance company for reimbursement.  You should be able to print claim forms from your insurance company’s website and submit it along with your therapy receipts.

Medicare Beneficiaries:  The US government has particular and interesting laws that control where Medicare beneficiaries are able to spend their money.  Restore Your Core is not a participating Medicare provider; therefore, we can only accept Medicare beneficiaries who do not want Medicare billed for any physical therapy services.  This request must be made by the patient upfront and of the patient’s own free will. This means that if you are adamant about seeing the therapists at Restore Your Core, fully understanding that we are not an enrolled Medicare provider, we can still see you if you request upfront that you do not want Medicare billed or involved in your physical therapy care.  If you do want to use your Medicare benefits, we will gladly refer you to a Medicare provider in your area.

How soon can I get an appointment?

It generally takes 6-8 weeks to schedule your initial appointment due to the highly specialized one-on-one care provided to each and every patient.  We do occasionally have cancellations and we move up the patients who are waiting.  After your initial evaluation, we will schedule your remaining sessions.  This will ensure that you will receive continuous care. 

What are your hours?

We offer varying appointments each day.  We offer some early morning appointments and some evening appointments. 

What will my first visit be like?

First, we will start your session by discussing why you referred yourself or why your physician referred you to physical therapy.  Next, we will take adequate time to discuss your past medical history, including all areas of pelvic functioning (urinary, bowel, bladder, and sexual).  Every aspect of your history will be taken into consideration in order to obtain a thorough understanding of the root cause of your current problem.  Then, a gentle physical therapy exam will be performed, which may include internal pelvic muscle evaluation, posture assessment, external joint and muscle evaluation, and a functional assessment.  Finally, we discuss the exam findings and how they are contributing to your problem.  We set wellness goals together.  An individualized therapy plan is created to meet those goals and a home exercise program is initiated.  We promise to make exams as pain free as possible. 

Is your Physical Therapy treatment painful?

My primary objective it to decrease your pain.  Many patients refer to Physical Therapy from a past experience or from listening to the past experience of a family member or friend by stating “no pain, no gain.”  I do not believe in this approach as previously stated my primary goal is to work with you to decrease and/or eliminate your pain.  Pain relief is frequently achieved with hands-on manual physical treatment and gentle exercise.  These treatments are designed to help you recover mobility, strength, endurance and function.

How many visits will it take to get better?

We will have a clearer picture of the answer to this question after your evaluation.  The number of visits required to decrease your pain and improve your function is highly variable and is dependent upon the chronicity and severity of your problem.  Most patients experience a decrease in pain and improvement of function within 4-6 sessions.  Those with acute issues such as urinary incontinence can anticipate improving at a much quicker rate than those with chronic pain issues.  You will be provided with a home exercise program which will consistently be updated throughout your therapy plan of care, giving you the tools you need for self-care.  Regular completion of your home program will decrease the need for extended therapy.

What should I bring to my first appointment?

  You should bring your completed paperwork which you will find under the forms tab.  If you do not have the ability to print your paperwork, please arrive 15 minutes prior to your appointment to complete the paperwork.  You will also need to bring a form of payment (cash, check, credit card).

What should I wear to my appointment?

Street clothes are fine or you are welcome to wear anything that you feel is comfortable and easy for you to move in during manual therapy and exercise.

Can I bring my child/children?

   Yes, you are welcome to bring your children to your session.  If they are under 16 years of age, they will be required to stay in the treatment room with you per facility policy.

What is your cancellation policy?

For initial evaluation (IE) visits there are no exceptions as we block out and fully devote 90 minutes to you.  Upon scheduling you IE, a $75.00 deposit will be required.  If you fail to keep your appointment, you will forgo the $75.00 deposit.  Note:  The $75.00 deposit will be credited towards your IE fee. 

For follow up visits, you will be billed the full amount of the scheduled session if you do not show for your appointment or if you do not cancel within 24 hours of your appointment time.  If your appointment is on a Monday, please notify the office by noon the day prior via email or voice mail to avoid being charged for your session.

***If there are severe weather conditions, please check your phone and email before attempting to drive to the office.  Please do not put yourself in harms way.

What if my pain returns after I have completed therapy?

When you are dealing with chronic pain, it is not uncommon to have flare-ups or worsening symptoms.  This can happen even after you have positively responded to therapy.  If this happens, we would like you to call us immediately before your symptoms get too far out of control.  It is much easier to restart and have success quickly than to wait until you are miserable again with pain.  A return of pain may mean that you need to cut back on your exercise program or revisit with your physician.  We will be happy to consult with you if this should happen.