Insurance Food for Thought
By Kandy
There are some insurance companies that cover CPT therapy on an out of network basis although you may feel more comfortable calling your insurance company to verify your benefits prior to receiving services from Clear Passage therapies. Since CPT does not participate with any insurance providers we are considered out of network for all insurance plans.
In today’s society we all need to lead a pro-active approach to not only our health but also to being informed and up to date on our insurance benefits. There are many different types of insurance companies and multiple different plans within each company. To help reduce the stress of whether or not your particular insurance provider will cover treatment with Clear Passage therapies please consider the below suggestions when contacting your insurance company.
Inquire to what type of out-of-network benefits are available to you for out-patient physical therapy as you are coming to CPT for treatment of pain and/or adhesions to be performed by licensed therapists. Specifically explain to your insurance provider that you are going to be receiving several hours of therapy per day (usually 4 hours a day over the course of a 5 day week for a total of 20 hours). The insurer may want to know why you are receiving more than one hour of therapy a day, please explain that you are attending an accelerated program for treatment of pelvic adhesions or physical therapy for pelvic or other related pain.
Educate the insurance company by letting them know that the reason you are going out of network for this service is because there are no clinics within your network that perform this particular specialized service, therefore your only option is to seek services outside the network. Also remind them that repeated diagnostic tests, hospital claims, and/or surgical interventions will in the long run cost the insurance company more money in paid claims than 20 hours of this accelerated therapy.
Another question that may arise by the insurance company is what procedural codes are going to be billed during your treatment with Clear Passage therapies. Please let them know that all of the codes being used are approved by the American Medical Association and include common physical therapy codes such as the following:
- 97001- Physical therapy Initial evaluation
- 97110- Therapeutic procedure
- 97112- neuromuscular reeducation
- 97140- manual therapy
- 97530- therapeutic activities to increase function
- 97535- self care education
Finally, find out at what level of reimbursement you can expect to receive from your insurance once you submit your claim. This way you will know what to expect beforehand.
