If you are currently considering an intensive week of treatment at CPT’s Florida location, you may wonder what you will be able to do in your free time.

The CPT therapists and staff encourage all patients to use their intensive week to restore their mind, body, and spirit. As CPT works to restore your body, you can use your free time to rejuvenate yourself and start a journey towards better mental, physical, and spiritual health. Gainesville provides many resources and opportunities to help you on your way. I highly suggest you take advantage of Gainesville’s many riches in this way:

Eat well. Nutrition greatly impacts your body. Use your week of treatment to make better eating choices. Gainesville offers many healthy places to eat. Try out the Booklover’s Vegan café. You can leisurely read while you eat delicious, local food at any time of the day. For a fantastic salad with a great atmosphere, head to Satchell’s. If you can’t tame your junk food craving, you can head to Leonardo’s Pizza and try a vegan pizza – along with vegan rolls! They also have great salads. If you want to curl up in your bed with some late-night snacks, you can head to Mother Earth for organic food of Fresh Market for great, healthy options.

University of Florida Chapel for Meditation and Reflection

Relax. Gainesville offers great, quiet places to sit and think in peace. For an incredible experience, I recommend you visit Lake Alice on the University of Florida’s campus. Not only are you likely to see alligators, but also huge Oak trees that drape across the lakeside trail – and don’t worry, no one has even been attacked by an alligator. If you continue on the path, you will find a nature trail in one direction and a chapel in the other. The chapel remains a relatively unknown jewel. It is a quiet sanctuary open to the public for meditation and self-reflection. As dusk approaches, head back along the path to the bat house. As the sky darkens, hundreds of bats swirl out in a breathtaking spiral.

Get in touch with nature. CPT therapists recommend all patients walk daily while undergoing treatment. One of the best places to do this is in nature. Gainesville is full of great parks that will quickly lead to a sense of awe and relaxation. If you are interested in a long walk, I highly recommend the Hawthorne State trail. I guarantee you will se an armadillo, deer, or alligator before your feet leave the path. I also suggest you slip into the Natural History Museum. The recreation of the Florida ecosystems is incredible. You walk inside, only to feel you stepped outside. The museum truly sucks you in to another world and will help you appreciate the Florida environment even more. You can also visit the museum’s butterfly rainforest.

Take a mini vacation. If you have time to schedule a mini-trip on the weekend, I highly suggest you take the opportunity to see some nearby areas in Florida. My top two recommendations:

• St Augustine: The oldest city in the U.S., St. Augustine is 1.5 hours to the east of Gainesville. It has an “old-city” charm with an artsy vibe, unique shopping, great food, beautiful beaches, and a castle!
• St. George Island. This is my personal favorite for someone who wants a quiet retreat to the most beautiful and quiet beach in Florida. It is a longer drive, perhaps four hours, but you won’t regret it. I suggest you stop half-way at Wakulla springs to go kayaking along the river and see manatees. Afterward, head to Apalachicola, a little sea-side town less than 15 minutes from St. George Island. Eat some great seafood and then slather on some sun screen to go check-out the island. Its crystal white beaches stretch for 25 miles alongside the emerald ocean. One third of the island is a state park: pristine, untouched, and open to the public. You can walk by yourself along the beaches without seeing a single tourist.

Gainesville and the surrounding area is a pretty incredible place. Don’t be afraid to ask CPT Florida therapists or staff for more information. This is our home and we’d love to share it with you.

Have you ever left an appointment with a healthcare provider feeling frustrated, or that your needs were not fully met? Did you feel that your healthcare provider did not listen to you? Or maybe you left the visit not fully understanding your diagnosis or why you need additional medications or tests? If any of the above scenarios sound familiar, you are not alone. Many of us have experienced this at one time or another, and sometimes more than once.

We all have the responsibility to take a pro-active role in our own well-being; we need to be in control of how we want our bodies to be treated and taken care of. After all, you are the true expert of your body. You live in it every day and experience the joys, sorrows, aches, and pains that no one else really knows. Therefore, we all need to have the tools to effectively and thoroughly communicate our needs to our healthcare provider.

Over the years I have complied and gathered the following suggestions which I have found to be beneficial for me during appointments and I hope that you might be able to add some of these suggestions to you own tool box for future reference.  

• Once your appointment has been scheduled with your healthcare provider, start compiling a list of any questions, symptoms, and concerns that you would like to have addressed during your visit. I find it useful to have a small notepad in my purse to jot down any questions that come to mind.
•  A couple of days prior to your appointment, go through your compiled list of questions and concerns. Review each item to make sure that you have been simple, direct, and to the point with your question. Next, prioritize each item in order of importance to you. (In my experience it has been beneficial to have the most important items discussed first.)
• Take your list with you to your appointment. Don’t be afraid to be direct with your questions. Remember, you are the expert on your body. Address each topic simply, but frankly. Write down your healthcare providers answers. If you do not understand the response from your healthcare provider, ask her/him to please repeat the answer in terminology that you are comfortable with. Address each item in the same manner.
• If something is being said that just “doesn’t feel right,” follow your intuition and speak up, letting the healthcare provider know your feelings. And remember, if you need time to think about an option, test, medication, or procedure, it is ok to take the time to think about it before agreeing to anything. The only exception to this would be in a life-threatening instance when you would need to make a decision on the spot.
• Once you reach the conclusion of your visit, summarize what your understanding is of each item addressed with your healthcare provider and ask if s/he has the same understanding.  

There is a multitude of material available to you on the internet on the topic of effective communication. For more information on tips to effectively communicate with your healthcare provider, I suggest checking out the following sites that may be of interest to you: www.healing.com and www.takingcarge.csh.umn.edu/healthcare_system/communicate

Access to the internet has created a multitude of options for people to consider when deciding on different healthcare treatments. Unfortunately there are “swindlers” out to make a buck off someone else; they feed upon others. How can you “weed” through the hundreds or thousands of treatments available for your particular diagnosis? How do you know what is legitimate and what really works?

One of the ways to start the “weeding-out” process is to look for any scientific studies that have been completed. Generally speaking, most reputable companies and treatment options will have scientifically backed research, studies, or abstracts available for review. When you look at the information provided, keep in mind the following questions:

• Have the studies been published in peer-reviewed journals? A peer-reviewed journal is one in which all journals have been anonymously reviewed by scholars in the field. This process ensures that the articles and studies use solid scholarship.
• Can you access the studies or abstracts? If a company or treatment option claims to have studies or abstracts, you should be able to access them. If not, the company may be making false claims.

A legitimate study will follow the scientific method, in which the following criteria occur:

1. Define the question
2. Gather the information and resources
3. Form a hypothesis
4. Perform experiment/tests and collect the data
5. Log analysis of the data
6. Interpret the data collected
7. Draw conclusions from the data collected during the experiment/tests
8. Publish the results for peer-review

I hope that this little introduction to the importance of having scientifically based studies & research with publication enables you to “weed” through the multitude of healthcare treatments available to you. If you are interested in the scientific research that Clear Passage Therapies has complied and published, please feel free to visit our research page.

Unfortunately the majority of us have had the experience of an insurance claim being denied. As a patient it can be quite mind boggling and extremely frustrating when you aren’t sure how to proceed. From my own past experiences, I understand that the process of “jumping through the hoops” to satisfy your insurance provider can be very aggravating; I hope that the following suggestions will be able to give you a better understanding of the initial steps of insurance appeal.

• If you have any questions on your policy benefits, I highly suggest you refresh your memory and read your policy thoroughly. I understand it’s not the novel of the century, but we, as the insured, are responsible for knowing our benefits. If you do not understand the benefits, call and speak with the customer service insurance representative and ask questions until you have a full understanding of the benefit coverage and policy limitations.

• Once you are in receipt of the explanation of benefits (EOB) that specifically states your claim is being rejected or denied, you have the right to request an appeal (or review) be performed by your insurance carrier. You may also want to contact the healthcare provider office where services were performed and inquire as to whether or not they have received a denial and what steps may have been taken in the process of getting your claim paid.

• Retrieve the documentation that you have on being referred, or the pre-certification information for the service performed. Secondly, request copies of all documentation that relates to the denied claim, whether it is office notes, surgical reports, diagnostic test results, etc. Then organize accordingly as this will be needed during your conversations and correspondence with your insurance provider.

• You can generally make initial contact to your insurance provider with a telephone call to the customer service department to request that a detailed explanation of the denial be reviewed with you. It is of extreme importance that every detail be documented, including the date & time of your call, whom you spoke with, and every detail of the discussion. This process will allow you to track each and every contact that is made whether with the insurance provider, the healthcare provider, or practitioner involved in the case.

• Inquire how to start the appeals process, as some insurance companies start with an informal appeal that is completed over the phone. (This is where your organized notes come in handy as you “bare the burden” of proving necessity of the performed service.) This is when you state “your case” and “prove” that the procedure, test, etc. was necessary, why it was performed, or why you had to go out of the approved network area for services. If a phone appeal is not allowed, then follow the steps the insurance company gives you. Copy all mailed correspondence and mail it certified mail with return receipt requested so that you have documentation of this correspondence also.

I cannot stress enough the importance of writing each and every detail down no matter how insignificant it may seem; after all, the insurance/customer service representative is notating every aspect of the call on his/her end, he/she may even be recording your call as is routine practice in the majority of instances, to avoid a “he said – she said” situation. The recorded call can be retrieved at any later date should it be needed. This is the insurance companies “proof” of what was said, agreed to, denied, or admitted to, etc.

• When you are speaking to the customer service insurance representative ask him/her to repeat their answer in terms that you are comfortable with. Write down their answer and then repeat it back to them so that you have a clear understanding of the answer. If you are not satisfied, ask the representative to please repeat it until you understand it.

• Usually, once the initial appeal process has been submitted, the insurance provider will inform you of how many days it will take for a review and response from them. If you have not received a response within the allotted time frame, call them again and inquire as to the hold-up on processing your claim. If a time frame is not given ask the representative to tell you how long the process of review is anticipated to take, and document, document, document.

• Should another EOB arrive that denies payment, request that your physician write an appeal letter notating the medical necessity and relevance of the procedure. Ask your physician to please send you a copy of all correspondence s/he has with the insurance provider.

• If a third denial should arrival and you feel that this claim should be paid, then you may be able to receive assistance from your state’s Department of Insurance also called the Department of Manage Care. You usually have a 50 – 50 chance of winning at this appeal as an independent panel of physicians performs this review.  However, if you are insured by a self-funded plan they may not be subject to state regulation and an appeal at the federal level may be necessary. In this case you would contact the Department of Pension & Welfare Benefits Administration. You have a chance here too of winning especially if the review panel finds any inconsistencies in payment that were made for other claims on the same plans.

This information is in no way a substitute for an appeal, nor does it explain individual insurance policy benefits. It is for informative purposes only and thorough research of your individual policy and guidelines should always be your first line of information. I hope that you find the information in this article to be of some use should you ever have the need to file an appeal.

There is a large amount of information on the internet about how to file an insurance appeal. For more information the following articles may be of interest to you also:

http://www.online-health-insurance.com/health-insurance-resources

http://www.ec-online.net/knowledge/Articles/meddenials.html

http://www.revolutionhealth.com/insurance/information

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.

One of the frequently asked questions I receive during a phone conversation with someone inquiring into Clear Passage is, “Why do I need to submit a health questionnaire before I can schedule services?” I hope the brief summary below will give you a better understanding as to the relevance of the health questionnaire.

The health questionnaire plays an important part in Clear Passage as it allows our therapists to review your past medical history which aids them in determining whether our services are appropriate for you.

Each individual has his/her own personal experiences in which you have lived through and the questionnaire is a tool used to help our therapists understand your individual needs and goals. For example, let’s say that you have a history of ovarian cysts, which you indicated on your questionnaire. However, if you did not completely fill in the section specially designed for cysts, that would then impair the review process as we would need additional information supporting any past actions taken regarding your ovarian cysts. In the end, we would request that you send us additional information to aid in a final determination as to whether our treatment is appropriate for you.

The questionnaire also assists our Therapist Director at the time of your phone consultation, as it gives her an opportunity to have a look at your past medical history which aids her during the question and answer process of the phone consultation.

I hope that this short summary has given you a better understanding of the relevance of the health questionnaire.  I look forward to having the opportunity to speak with you!