Frequently Asked Questions
Damien Howell Physical Therapy does not take health insurance payments. The practice is a cash based Physical Therapy practice. The services are considered out of network for all health insurance companies. Documentation will be provided along with directions on how you can submit a claim (insert hyperlink to pdf) to your health insurance plan for out of network benefits.
Damien Howell Physical Therapy is not a Medicare provider. If you are Medicare beneficiary and still would like to receive service or have questions, please call me for options 804-647-9499.
Call the toll free # for customer service on your insurance card. Select the option that will allow you to speak with a customer service provider, not an automated system. Ask the customer service provider to quote your physical therapy benefits in general. These are frequently termed rehabilitation benefits and can include occupational therapy, speech therapy, and sometimes massage therapy.
Make sure the customer service provider understands you are seeing a non-preferred or out-of-network provider.
What you need to know:
- Do you have a deductible? Yes / No. If yes, how much is it? How much has already been met? What percentage of reimbursement do you have? (60%, 80%, 90 %,)? Does the rate of reimbursement change because you’re seeing a non-preferred provider?
- Does your policy require pre-authorization or a referral on file for outpatient physical therapy services? If yes how do I obtain it?
- Is there a $ or visit limit per year? If yes what is it and how much do I have left?
- Is a special form required to submit a claim? What is mailing or web address to submit claim?
What this information means:
- A deductible must be satisfied before the insurance company will pay for therapy treatment. Submit all bills to help reach the deductible amount.
- If you have an office visit co-pay the insurance company will subtract that amount from the percentage they will pay. This will affect the amount of reimbursement you will receive.
- The reimbursement percentage will be based on your insurance company’s established “reasonable and customary/fair price” for the service codes rendered. This price will not necessarily match the charges billed; some may be less, some may be more.
- If your health insurance policy requires a prescription or referral from your primary care physician you must obtain one to send in with the claim. If the referral from a physician is required by the health insurance policies make sure to have a copy to include with your claim. Each time you receive an updated referral you’ll need to include it with the claim.
- If your policy requires pre-authorization or a referral on file and the insurance company doesn’t have one listed yet, you’ll need to call the referral coordinator at your PCP’s office. Ask them to file a referral for your physical therapy treatment that is dated to cover your first physical therapy visit. Be aware that referrals and pre-authorizations have an expiration date and some set a visit limit. If you are approaching the expiration date or visit limit you’ll need the physicians’ referral coordinator to submit a request for more treatment.
This worksheet was created to assist you in obtaining reimbursement for Physical Therapy services & is not a guarantee of reimbursement to you.
If you have a health insurance plan with a high deductible, and are healthy, using cash based fee for service makes sense. Damien Howell Physical Therapy provides statements to you which you can submit and apply to your out of network deductible. All of the time during the visit with Damien is one on one. If you are going to pay for skilled Physical Therapy visit, it makes sense to spend all of the time with the Therapist, as opposed to a PT Tech or exercising on your own during the PT clinic visit.
If you have used all your allotted visits allowed by your health insurance plan for the year and you need additional Physical Therapy, using traditional insurance based Physical Therapy will be higher than using cash based Physical Therapy services. You will be responsible for the entire bill including co-pay. And, the time spent with the skilled Physical Therapists typically is only 15 minutes/visit.
If you do not have health insurance the quality and efficiency of cashed based fee for service Physical Therapy is better than traditional insurance Physical Therapy.
Yes, the services provided by Damien Howell Physical Therapy qualify for Health Savings Account or Flexible Spending Account re-imbursements. Request a claim form from your Health Savings Account Agency. The necessary receipt will be provided so that you can submit a claim for reimbursement.
No, the expense of this type of healthcare is not necessarily more expensive than insurance based healthcare "it is differently expensive".
The expense/cost can be less than traditional insurance based Physical Therapy. National benchmarks for traditional health insurance based Physical Therapy is typically10 Physical Therapy visits per episode of care. Damien Howell has honed his craft to a point where the average number of visits per episode of care is 3 visits. Using a standard outcome measure that is used by over 7 million Physical Therapists his score for improvement per visit ranks in the 97th percentile. Damien provides effective and efficient service. If you combine, time saved, less time in pain, less time traveling to clinic, greater knowledge and understanding of your problem and being empowered to self-manage the problem, At-Home, At-Office, and At Fitness Facility Cash Based Service can be a real bargain.
Physical Therapy services that is not burdened and restricted by the requirments and limitations of the health insurance plans. This provides a unique opportunity to take control of your problem. Cash based service allows us to have one on one quality time. Depending on what your expectations and goals are you can have a Physical Therapy visit last as long as you want or as short as you want. Depending on what your expectations and goals are you can have as many Physical Therapy visits as you want or as few visits as you want. We have control.
Together we can take the time to identify, clarify and measure your expectations and goals. We can become a team without hassles from a health insurance company. When the goals and expectations are agreed upon as Steven Covey said, we “can begin with the end in mind”. If we do not come to agreement on your expectations and goals, you will be assisted in finding a more appropriate healthcare professional team member to help.
Give Damien a phone call for a free consultation 804-647-9499. Damien will provide details of benefits and costs of cash based Physical Therapy and a worksheet you can use to determine what your health insurance benefits and costs for Physical Therapy would be. You can than compare to determine if using cash based Physical Therapy makes sense.
As a post-polio victim, I have been off my feet in sit-down jobs for many years. Nearly completely confined to a wheelchair now I recently sought help in becoming more physically mobile so I could escape the helplessness I could see for myself in the near future.
My daughter kept urging me to call Damien. Knowing I could not make trips to an office (even driving was a problem now) I was overjoyed to hear that he makes house calls!
Damien is quick to analyze the core problems, and even checked through my home to assess how I was coping with different safety issues. Believe me, that is a much-needed service for a disabled person living alone -- suggesting efficient and safe ways to deal on a daily basis.
Whereas another physical therapist told me, "I wouldn't know where to begin," Damien has me doing the exercises twice daily that I need to get back on my feet.
This is the only kind of physical therapy that makes sense to me. I worked in a physical therapist's office for five years and know that none of the patients I saw there were getting the personalized, dedicated, common-sense treatment that I'm getting from Damien Howell.
~ Deanna Holloway