We are an out-of-network provider for physical therapy in order to treat patients one-on-one and deliver the proper care it take to get you better. We are truly a one-on-one office. JUST YOU AND THE PHYSICAL THERAPIST!
Here are some commonly asked questions we get in the office ! We always suggest you call us with your insurance information and our staff will gladly assist and call on your benefits and give you EXACTLY what you are responsible for. YOUR HEALTH IS WORTH IT!
Does NY Sports and Spinal Physical Therapy accept insurances?
Of Course we do! All Cigna, United HealthCare, Oxford, Blue Cross Blue Shield, Aetna and Magna Care community are welcomed with out of network benefits. All plans except for Medicare are out of network. If you don’t see your plan here, gives a call and we will check for you.
So, what don’t you accept?
Unfortunately 1199, GHI, Medicaid, No fault, Pomco, and Workers Compensation Networks are not accepted. We do offer great out of pocket rates with awesome benefits.
What will my copay be? Will I end up paying all my therapy out of pocket?
It all depends on your health plan; your best guarantee is too call the office. Provide us with your Name, Date of Birth, and Insurance information; let us handle the dirty work. An estimate of your Patient Responsibility* will be given to you before your first visit. Once we inform you of your benefits, please arrive with form of payment. We accept all major credit cards, cash, and checks. * Keep in mind a patient responsibility will be subject to your Deductible or Co-Insurance with your plan.
How about my monstrous deductible?
We wish we could evaporate deductibles into thin air! Unfortunately we can’t, but we do offer rates that help you meet your deductible in a short amount of time, with less cost to you. Each rate is different for everyone, so please call us and let us deal with that burden.
Q: Is a referral or prescription required for physical therapy?
A: No, the cool part of New York State, is they have “direct access”. This means you’re allowed to physical therapy for 10 visits or up to 30 days; whichever comes first. After 10 visits, a follow up with your PCP is necessary, to ensure we are doing an awesome job! – Keep in mind some insurance plans require prescriptions regardless of NYS law.
**Medicare Community: this does not apply to you. Yes, we know complete bummer. No worries, we have a section just for you.**
Q: What if I do not have any out-of-network benefits?
A: No worries! We offer a Special rate for One Hour sessions One-on –One with our exclusive therapists. This means you get the therapist all to yourself!
How much will I pay for physical therapy?
It all depends on your secondary benefits. In some cases, secondary insurances do not cover Medicare deductibles, or have benefits of their own that subject you to a copay. Our best advice, call us and let us handle the dirty work. We will give you a call back and give you all the nitty gritty.
How much is the Medicare deductible?
Medicare has a flat annual deductible of $147.00. Most secondary plans, pick up the deductible but in the case that they don’t, no worries, we can offer you payment plans to have it satisfied.
Do I need a prescription?
Yes, Medicare requires a prescription for all therapy services. Once you begin treatment with us we keep track of your prescription, and take the time to contact your PCP when a renewal is needed. If your PCP decides that you need to follow up, then we will inform you so that you can schedule an appointment with them.
When we go into beast mode, to obtain your benefits from your insurance plan, we might talk to you in an alien language. So we’ve gone ahead and made a glossary with key words you’ll hear:
Deductible: An amount you owe for medical services before your health insurance plan begins to pay.
Co-Insurance: This is your share of the costs of covered medical services. It’s determined by a percentage, for example, your plan covers 80% after your deductible; then 20% is your co-insurance.
Co-payment: A flat rate you pay for covered medical services. For example, if your copay is $15, than every visit will be $15.00.
Medically Necessary: Medical services or supplies that are needed to prevent, diagnose or treat an illness, injury, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.
Non Preferred Provider/Out of Network Provider: A provider who doesn’t have a contract with your health insurer.
Out of Pocket Limit: The most you pay during a policy period (usually a year) before your health plan begins to cover 100% of allowed amount. Some health plans do not count copays, deductible, or co-insurance payments toward this limit.
Allowed Amount: Also known as “eligible expense”, “payment allowance”, or “negotiated rate”, this is the maximum amount on which payment is based for covered medical services.
Preauthorization: Also known as “precertification”, “prior approval”, or “prior authorization” is a decision by your health insurer or plan that determines if a medical service or treatment plan is medically necessary. Your health insurer or plan may require preauthorization prior to you receiving medical service, except in an emergency. *No need to worry about this, we take care of any authorizations for you throughout your treatment time.
Rehabilitation Services: either occupational or physical therapy services that help a patient keep, get back or improve skills and functioning for daily living that have been lost. Usually done at inpatient and/or outpatient settings.
Specialist: A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.
Primary Care Physician (PCP): This is your primary physician that is given to you by your health insurer or you have chosen. Physician that refers you to a specialist when needed.