Total Potential FAQ
We have compiled the following list of frequently asked questions based on years of successfully treating people with injuries.
If you have any additional questions, please feel free to contact us directly via email, or you can call/text us at (424) 254-9273. If it’s after business hours, click here to schedule a free phone consultation to discuss your specific pain/injury with an expert manual physical therapist.
What injuries, body parts, and syndromes are treated at Total Potential?
We successfully treat the vast majority of pain/injuries of the muscles, joints, nerves, and organs throughout the body. You can learn more here.
Our physical therapy success stories include patients dealing with everything from headaches and neck pain to bunions and ankle sprains; from knee, hip and low back pain to rotator cuff tears and tennis elbow. We’re also great at helping wrist and hand pain, and have a lot of experience treating TMJ (Temporomandibular Joint) problems and nerve related problems as well.
Chances are that if your pain/limitation is due to a muscle, joint, or nerve, and doesn’t require surgery, we can help (and we’ve had plenty of patients who were told they needed surgery but their pain was resolved with our treatments).
So that’s a little about what we treat at Total Potential. Here’s a little bit about our patients…
The majority of our patients are highly active and highly motivated to move, look, and perform their best. Exercise/sport are very important to them and they also place a high value on their time.
When they have an injury or pain that is keeping them from staying fit and performing well, they want the highest quality, one-on-one care and usually don’t have the time to go to a clinic 2-3 times a week for 2 months; and they certainly don’t appreciate being asked to do things in the clinic that they could easily do on their own time (like stretches and exercises).
How is it possible for these treatments to resolve pain and injuries so much faster than other healthcare practitioners I have seen in the past?
After injury, most people visit an orthopedic specialist or general practitioner. If the injury is not in need of surgery, the common plan of care involves medications as needed for pain, inflammation, and/or spasm; and referral to Physical Therapy.
Though there is certainly a place for these medications, it is important to know that they are treating the symptoms and secondary results of the injury, NOT the cause of the symptoms and inflammation.
In traditional Physical Therapy, there is a large emphasis on modalities (ultrasound, electrical stimulation, heat/cold packs, etc) and exercises to help ‘set the stage’ for the body to heal the injured tissues, resolve excessive inflammation, and regain strength and range of motion. The focus is now more on the causes of pain and dysfunction, but still relies heavily on the body’s lengthy process of the healing itself.
Something many do not know is that what usually makes progress not as quickly as can be is that traditional Physical Therapy treats only in the regional area that is painful and seeks to restore normative values. Functional Manual Therapy® (FMT) is a way of looking at a patient, founded and developed by the Institute of Physical Art (IPA). It looks beyond normative values but the innate human potential instead. Breakthroughs in the development of FMT were made working with professional dancers, runners, and complex cases. Because of this "out of the box" thinking, problems were solved brilliantly and in curious ways. FMT is a full body approach to treating the body's tissues to promote functional efficiency.
The speed of recovery and response to any treatment is influenced by a large number of factors including age, length of time since the original injury, and any underlying causes of the pain. However, incorporating a hands-on manual therapy component of treatment can usually resolve pain and injury much faster than most/all other treatment options available.
So with our unique hands-on treatment approach and the fact that every session is a full hour of one-on-one care, our patients tend to need far fewer total visits than they would at most other clinics.
What is Functional Manual Therapy® (FMT)?
Functional Manual Therapy® (FMT) is manual therapy that looks at the human body in a 3-dimensional manner. It is a constant evaluation and treatment of the 3-pillars of the FMT paradigm: mechanical capacity, neuromuscular function, and motor control.
Its mechanical treatment is end-feel directed rather than soley on position, motion, and symmetry. FMT was developed under the
principles of Proprioceptive Neuromuscular Facilitation (PNF). So the treatment sessions literally feel like dancing and flowing to help make patients better.
Mechanical capacity is evaluated and treated with Functional Movement Patterns (FMPs) which make mobilizations laser-specific, rather than passive mobilizations of laying passively on the treatment table. This is why we say that we're doing something WITH you rather than something happening TO you. FMPs reveal the exact motion and position that was directly affecting the specific region in question. Physical therapy diagnosis and treatment becomes fast, seamless, and creates immediate results.
The second pillar, neuromuscular function, uses our hands to activate very specific fibers of the core rather than requiring multiple physical therapy visits and 1-hour long home programs with multiple repetitions and conscious mental effort to isolate specific fibers with weights and bands for weeks on end. Because PNF is like dancing and integrating with the innate human design, it's effectiveness is exceptional--thus faster--at diagnosing and treating initiation, strength, endurance, and elongation of various deep cores of the body, getting results quicker and safer.
Motor control is the final pillar of the FMT approach. Our hands and observation skills continuously uses PNF principles to treat the movements that you care about. We take specific movements that do not look and feel right, treat out the mechanical dysfunctions, restore the neuromuscular function with PNF and FMPs, and apply it back to the motor control system revealing effortless movement that just seems to magically flow with the rest of the human system. This final pillar is where prescriptive exercise can become highly beneficial to help you get the results you need.
Voilà!
How long after an injury should I wait to get treatment?
In general, the longer you wait to get treatment, the longer it will take to fix the injury and get you back to 100%. Moving the tissues back into their pre-injury arrangement becomes harder the longer they have been in a distorted/injured state.
Additionally, the longer an injury has been present, the more loss of strength that occurs and the more likely that detrimental movement “compensations” will develop that can lead to injury in other areas.
So it’s important to get treatment as soon as possible after injury if you want to get better with the fewest possible sessions. With all that said, we have plenty of patients at Total Potential who have been dealing with their pain for decades and we are still able to significantly improve their condition.
Will I have to stop participating in my sport/exercise routine while I am getting treatment?
Occasionally, complete rest from a painful activity is necessary to allow for the most rapid and full recovery, but it is often possible to continue your sport/exercise to some degree while we are treating your injury. It really depends on a lot of factors and is ultimately your choice.
We pride ourselves on getting our patients back to the activities they love as soon as possible, and though full rest is occasionally necessary, we usually have them performing these activities throughout their care. After all, we can’t say that you’re “fixed” until you can do the things you want without pain, right?
How many treatments will I need till I’m 100% again?
This is always a tricky question, because it varies with every patient and is dependent on a large number of factors. What we can say is that, for reasons described above, you will usually need far fewer treatments at Total Potential than you would if you were going to a more traditional PT clinic or Chiropractor.
Pain and dysfunction that has been present for a long time will usually, but not always, take longer to fix than more recent/acute problems. Certain conditions like herniated spinal disks and frozen shoulders will take longer to resolve than something like an ankle sprain. And though notoriously ‘stubborn’ conditions like tennis elbow and plantar fasciitis can sometimes be fixed in a just a few treatments, conditions like these also have a tendency to need multiple treatments.
In general, it is rare that we need more than 5-7 treatments for the average patient, and quite often 2-4 treatments are all that is needed. In an industry where 2-3 treatments/week for 1-2 months is the norm, that’s quite good. But again, factors like age, severity of injury, other health issues, and how long you’ve been in pain can occasionally make the path to 100% somewhat lengthy.
Before we’ve had a chance to meet you and evaluate your condition, there’s no way to say how long it will take to fix your specific injury, but we should be able to give you a pretty close estimate at our first visit; and that first visit can be in the form of a Free Consultation called a “Discovery Session.” Click here to inquire about one scheduling one of these free sessions.
Why is insurance not billed at Total Potential? And did you say that can actualy save me money?
The short answer:
In many ways, insurance companies dictate or strongly influence the treatment that patients receive at “in-network” clinics, and we refuse to allow that to be the case at Total Potential.
The longer answer:
We are an out-of-network practice because the business model necessary for an in-network practice to survive rarely ever allows for the high-level care we insist on giving our patients.
What the heck does that mean? …
Due to progressively worsening reimbursement rates and pressure from insurance companies, the therapists at in-network clinics have to see at least 2 patients per hour (usually many more) and they often use technicians and assistants to provide much of the actual patient care. The care often includes modalities like heat packs and ultrasound, and the majority of a patient’s time at the clinic is spent doing exercises they could do on their own time. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week.
We do not believe that modalities are nearly as effective as our hands-on treatment, and we also do not agree with having patients pay to perform exercises in the clinic that they can easily perform at home or at a gym.
All of our patients receive one-on-one care and hands-on treatment from a Doctor of Physical Therapy in every session. Most sessions are a full hour unless the patient chooses 30 minute sessions. With this long-session, one-on-one treatment approach, the plan of care for the vast majority of our patients only involves one appointment per week.
When you consider the time savings of fewer trips to the clinic and the value of resolving your pain so much faster than average, the out-of-pocket expense at Total Potential is a huge bargain.
On top of that, the out-of-pocket expense for our treatment sessions is sometimes less than a patient would pay at a clinic that accepts and bills their insurance.
How is that possible?!
As deductibles and PT copays have skyrocketed in recent years, many of our patients who have high PT copays or have not met their deductible pay less out of pocket for our treatments than they would if they went to a clinic that “takes their insurance.”
So before deciding on where to get PT based solely on which clinics “take your insurance,” make sure you know how much you’ll be paying at your in-network options versus an out-of-network clinic like ours …
These days, some insurance plans provide zero coverage for PT visits or require copays of over $50/visit. And if you have a deductible to meet, you’ll likely end up paying the full bill for your PT sessions until you meet the deductible (and these bills are often $200+ per session). However, you usually won’t start receiving those $200+ bills until after you’ve been getting care for 6-8 weeks and have racked up an enormous total balance (again, often being asked to attend PT 2-3 times per week).
And guess what else… just because you’re paying $200+ per session at a clinic that is in-network with your insurance, does not mean that your insurance is applying that full amount towards your deductible! They often only apply the amount that they have agreed is reasonable for your PT sessions which is, of course, far less than the amount the PT clinic actually charges.
Most people are quite unaware of the games their insurance companies play in order to pay out as little as possible and maximize their profits. So as you weigh your PT options, it’s very important to:
1. Inquire with your insurance company about what percentage of the total PT bill you will be required to pay at an in-network clinic (especially if you still have a deductible to meet). If you will be paying 100% of the bill till you’ve met your deductible, ask the prospective PT clinic the amount of the average bill sent to an insurance company (the PT clinic’s amount on the bill … NOT what the insurance company has agreed they will pay the clinic). In most cases, you will ultimately be paying the full bill until your deductible is met.
2. If you have met your deductible, ask how much your copays will be? Ask how many times per week the average patient is asked to come in for treatment.
3. Consider the quality of care you’ll be receiving at your various options, and how much value you place on receiving higher-quality, one-on-one care from a Doctor of Physical Therapy rather than a PT Assistant (PTA) or an unskilled “Tech.”
4. Consider how often you’ll be missing work and/or time with family to attend your PT sessions. Again, you can ask any prospective clinic how many times per week their average patient is asked to come in for treatment.
Ask the above questions, do the math, and you may be quite surprised at what you find!
* One other thing to consider is whether or not you have just one deductible or if you have both an in-network deductible and an out-of-network deductible. If you have two deductibles, then claims from an out-of-network clinic like ours will not apply to your in-network deductible.
With all the above information, you can now get a real sense of what your true costs will be, what level of care you’ll be getting, and then make the best decision on where to receive your physical therapy treatment.
Can I bill my insurance for reimbursement of my out-of-pocket expenses?
This depends on the insurance you have, but YES, most NON-Medicare patients can send “self-claims” to their insurance company for their treatments at our clinic. We have partnered with Reimbusify to provide a unique service for our patients to submit Out-of-Network (OON) claims in less than a minute. We did this so that you can focus on getting the treatment that you need rather than spending your time and money on submitting self-claims. In addition, you can click here to file your claim FREE for this practice.
The amount of reimbursement or application towards your deductible is completely dependent on your insurance plan. If you call your insurance company to inquire about what you can expect to receive, you should ask about reimbursement for “out-of-network Physical Therapy” expenses sent in via self-claims.
Medicare Beneficiaries: The US government has some interesting laws that control where Medicare beneficiaries can spend their healthcare dollar and persuade healthcare providers to enroll in their system. Because we are not Participating Medicare Providers, we can only accept Medicare beneficiaries as patients when the patient does not want Medicare billed for any PT services. This request to not involve Medicare in payment must be made up front by the patient and be made of the patient’s own free will.
In other words, if you’re a Medicare beneficiary and are adamant about seeing us for your care even though we are not participating Medicare providers, we can help … However, the only way we can provide you with PT services is when you truly don’t want Medicare involved and you ask up front that Medicare not be billed or involved in your physical therapy care.
If you do want to use your Medicare benefits for physical therapy, we cannot provide you with treatment at our clinic but we can help you find a good Medicare provider in your area.
Do I have to have a “PT referral” to start treatment?
New regulations allow Physical Therapist to evaluate your injury without a referral and provide treatment for a limited number of days if the PT meets the following criteria:
In order to provide treatment without a script/referral to a patient for ten consecutive business days, the PT must possess a doctoral degree in physical therapy or have completed thirty (30) continuing competence units in differential diagnosis. If a PT with a doctoral degree has completed a fellowship or residency, the number increases to 15 consecutive business days.
All patients without a referral must sign a disclosure form prior to treatment. At Total Potential all our PT’s can with start treatment without a referral. A referral can come from an MD, DO, Physician’s Assistant, Advanced Nurse Practitioner, Dentist, Podiatrist, or a Chiropractor… and it can come from any of these professionals licensed anywhere in the United States.
This has nothing to do with insurance regulations or reimbursement, and it still applies to our clinic even though were are not in-network with insurances.
If obtaining a PT Referral is proving difficult, please let us know as soon as possible and we can suggest a variety of options for getting one quickly and easily.
If you have any additional questions, please feel free to contact us directly via email, or you can call/text us at (424) 254-9273. If it’s after business hours, click here to schedule a free phone consultation to discuss your specific pain/injury with an expert manual physical therapist.
What injuries, body parts, and syndromes are treated at Total Potential?
We successfully treat the vast majority of pain/injuries of the muscles, joints, nerves, and organs throughout the body. You can learn more here.
Our physical therapy success stories include patients dealing with everything from headaches and neck pain to bunions and ankle sprains; from knee, hip and low back pain to rotator cuff tears and tennis elbow. We’re also great at helping wrist and hand pain, and have a lot of experience treating TMJ (Temporomandibular Joint) problems and nerve related problems as well.
Chances are that if your pain/limitation is due to a muscle, joint, or nerve, and doesn’t require surgery, we can help (and we’ve had plenty of patients who were told they needed surgery but their pain was resolved with our treatments).
So that’s a little about what we treat at Total Potential. Here’s a little bit about our patients…
The majority of our patients are highly active and highly motivated to move, look, and perform their best. Exercise/sport are very important to them and they also place a high value on their time.
When they have an injury or pain that is keeping them from staying fit and performing well, they want the highest quality, one-on-one care and usually don’t have the time to go to a clinic 2-3 times a week for 2 months; and they certainly don’t appreciate being asked to do things in the clinic that they could easily do on their own time (like stretches and exercises).
How is it possible for these treatments to resolve pain and injuries so much faster than other healthcare practitioners I have seen in the past?
After injury, most people visit an orthopedic specialist or general practitioner. If the injury is not in need of surgery, the common plan of care involves medications as needed for pain, inflammation, and/or spasm; and referral to Physical Therapy.
Though there is certainly a place for these medications, it is important to know that they are treating the symptoms and secondary results of the injury, NOT the cause of the symptoms and inflammation.
In traditional Physical Therapy, there is a large emphasis on modalities (ultrasound, electrical stimulation, heat/cold packs, etc) and exercises to help ‘set the stage’ for the body to heal the injured tissues, resolve excessive inflammation, and regain strength and range of motion. The focus is now more on the causes of pain and dysfunction, but still relies heavily on the body’s lengthy process of the healing itself.
Something many do not know is that what usually makes progress not as quickly as can be is that traditional Physical Therapy treats only in the regional area that is painful and seeks to restore normative values. Functional Manual Therapy® (FMT) is a way of looking at a patient, founded and developed by the Institute of Physical Art (IPA). It looks beyond normative values but the innate human potential instead. Breakthroughs in the development of FMT were made working with professional dancers, runners, and complex cases. Because of this "out of the box" thinking, problems were solved brilliantly and in curious ways. FMT is a full body approach to treating the body's tissues to promote functional efficiency.
The speed of recovery and response to any treatment is influenced by a large number of factors including age, length of time since the original injury, and any underlying causes of the pain. However, incorporating a hands-on manual therapy component of treatment can usually resolve pain and injury much faster than most/all other treatment options available.
So with our unique hands-on treatment approach and the fact that every session is a full hour of one-on-one care, our patients tend to need far fewer total visits than they would at most other clinics.
What is Functional Manual Therapy® (FMT)?
Functional Manual Therapy® (FMT) is manual therapy that looks at the human body in a 3-dimensional manner. It is a constant evaluation and treatment of the 3-pillars of the FMT paradigm: mechanical capacity, neuromuscular function, and motor control.
Its mechanical treatment is end-feel directed rather than soley on position, motion, and symmetry. FMT was developed under the
principles of Proprioceptive Neuromuscular Facilitation (PNF). So the treatment sessions literally feel like dancing and flowing to help make patients better.
Mechanical capacity is evaluated and treated with Functional Movement Patterns (FMPs) which make mobilizations laser-specific, rather than passive mobilizations of laying passively on the treatment table. This is why we say that we're doing something WITH you rather than something happening TO you. FMPs reveal the exact motion and position that was directly affecting the specific region in question. Physical therapy diagnosis and treatment becomes fast, seamless, and creates immediate results.
The second pillar, neuromuscular function, uses our hands to activate very specific fibers of the core rather than requiring multiple physical therapy visits and 1-hour long home programs with multiple repetitions and conscious mental effort to isolate specific fibers with weights and bands for weeks on end. Because PNF is like dancing and integrating with the innate human design, it's effectiveness is exceptional--thus faster--at diagnosing and treating initiation, strength, endurance, and elongation of various deep cores of the body, getting results quicker and safer.
Motor control is the final pillar of the FMT approach. Our hands and observation skills continuously uses PNF principles to treat the movements that you care about. We take specific movements that do not look and feel right, treat out the mechanical dysfunctions, restore the neuromuscular function with PNF and FMPs, and apply it back to the motor control system revealing effortless movement that just seems to magically flow with the rest of the human system. This final pillar is where prescriptive exercise can become highly beneficial to help you get the results you need.
Voilà!
How long after an injury should I wait to get treatment?
In general, the longer you wait to get treatment, the longer it will take to fix the injury and get you back to 100%. Moving the tissues back into their pre-injury arrangement becomes harder the longer they have been in a distorted/injured state.
Additionally, the longer an injury has been present, the more loss of strength that occurs and the more likely that detrimental movement “compensations” will develop that can lead to injury in other areas.
So it’s important to get treatment as soon as possible after injury if you want to get better with the fewest possible sessions. With all that said, we have plenty of patients at Total Potential who have been dealing with their pain for decades and we are still able to significantly improve their condition.
Will I have to stop participating in my sport/exercise routine while I am getting treatment?
Occasionally, complete rest from a painful activity is necessary to allow for the most rapid and full recovery, but it is often possible to continue your sport/exercise to some degree while we are treating your injury. It really depends on a lot of factors and is ultimately your choice.
We pride ourselves on getting our patients back to the activities they love as soon as possible, and though full rest is occasionally necessary, we usually have them performing these activities throughout their care. After all, we can’t say that you’re “fixed” until you can do the things you want without pain, right?
How many treatments will I need till I’m 100% again?
This is always a tricky question, because it varies with every patient and is dependent on a large number of factors. What we can say is that, for reasons described above, you will usually need far fewer treatments at Total Potential than you would if you were going to a more traditional PT clinic or Chiropractor.
Pain and dysfunction that has been present for a long time will usually, but not always, take longer to fix than more recent/acute problems. Certain conditions like herniated spinal disks and frozen shoulders will take longer to resolve than something like an ankle sprain. And though notoriously ‘stubborn’ conditions like tennis elbow and plantar fasciitis can sometimes be fixed in a just a few treatments, conditions like these also have a tendency to need multiple treatments.
In general, it is rare that we need more than 5-7 treatments for the average patient, and quite often 2-4 treatments are all that is needed. In an industry where 2-3 treatments/week for 1-2 months is the norm, that’s quite good. But again, factors like age, severity of injury, other health issues, and how long you’ve been in pain can occasionally make the path to 100% somewhat lengthy.
Before we’ve had a chance to meet you and evaluate your condition, there’s no way to say how long it will take to fix your specific injury, but we should be able to give you a pretty close estimate at our first visit; and that first visit can be in the form of a Free Consultation called a “Discovery Session.” Click here to inquire about one scheduling one of these free sessions.
Why is insurance not billed at Total Potential? And did you say that can actualy save me money?
The short answer:
In many ways, insurance companies dictate or strongly influence the treatment that patients receive at “in-network” clinics, and we refuse to allow that to be the case at Total Potential.
The longer answer:
We are an out-of-network practice because the business model necessary for an in-network practice to survive rarely ever allows for the high-level care we insist on giving our patients.
What the heck does that mean? …
Due to progressively worsening reimbursement rates and pressure from insurance companies, the therapists at in-network clinics have to see at least 2 patients per hour (usually many more) and they often use technicians and assistants to provide much of the actual patient care. The care often includes modalities like heat packs and ultrasound, and the majority of a patient’s time at the clinic is spent doing exercises they could do on their own time. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week.
We do not believe that modalities are nearly as effective as our hands-on treatment, and we also do not agree with having patients pay to perform exercises in the clinic that they can easily perform at home or at a gym.
All of our patients receive one-on-one care and hands-on treatment from a Doctor of Physical Therapy in every session. Most sessions are a full hour unless the patient chooses 30 minute sessions. With this long-session, one-on-one treatment approach, the plan of care for the vast majority of our patients only involves one appointment per week.
When you consider the time savings of fewer trips to the clinic and the value of resolving your pain so much faster than average, the out-of-pocket expense at Total Potential is a huge bargain.
On top of that, the out-of-pocket expense for our treatment sessions is sometimes less than a patient would pay at a clinic that accepts and bills their insurance.
How is that possible?!
As deductibles and PT copays have skyrocketed in recent years, many of our patients who have high PT copays or have not met their deductible pay less out of pocket for our treatments than they would if they went to a clinic that “takes their insurance.”
So before deciding on where to get PT based solely on which clinics “take your insurance,” make sure you know how much you’ll be paying at your in-network options versus an out-of-network clinic like ours …
These days, some insurance plans provide zero coverage for PT visits or require copays of over $50/visit. And if you have a deductible to meet, you’ll likely end up paying the full bill for your PT sessions until you meet the deductible (and these bills are often $200+ per session). However, you usually won’t start receiving those $200+ bills until after you’ve been getting care for 6-8 weeks and have racked up an enormous total balance (again, often being asked to attend PT 2-3 times per week).
And guess what else… just because you’re paying $200+ per session at a clinic that is in-network with your insurance, does not mean that your insurance is applying that full amount towards your deductible! They often only apply the amount that they have agreed is reasonable for your PT sessions which is, of course, far less than the amount the PT clinic actually charges.
Most people are quite unaware of the games their insurance companies play in order to pay out as little as possible and maximize their profits. So as you weigh your PT options, it’s very important to:
1. Inquire with your insurance company about what percentage of the total PT bill you will be required to pay at an in-network clinic (especially if you still have a deductible to meet). If you will be paying 100% of the bill till you’ve met your deductible, ask the prospective PT clinic the amount of the average bill sent to an insurance company (the PT clinic’s amount on the bill … NOT what the insurance company has agreed they will pay the clinic). In most cases, you will ultimately be paying the full bill until your deductible is met.
2. If you have met your deductible, ask how much your copays will be? Ask how many times per week the average patient is asked to come in for treatment.
3. Consider the quality of care you’ll be receiving at your various options, and how much value you place on receiving higher-quality, one-on-one care from a Doctor of Physical Therapy rather than a PT Assistant (PTA) or an unskilled “Tech.”
4. Consider how often you’ll be missing work and/or time with family to attend your PT sessions. Again, you can ask any prospective clinic how many times per week their average patient is asked to come in for treatment.
Ask the above questions, do the math, and you may be quite surprised at what you find!
* One other thing to consider is whether or not you have just one deductible or if you have both an in-network deductible and an out-of-network deductible. If you have two deductibles, then claims from an out-of-network clinic like ours will not apply to your in-network deductible.
With all the above information, you can now get a real sense of what your true costs will be, what level of care you’ll be getting, and then make the best decision on where to receive your physical therapy treatment.
Can I bill my insurance for reimbursement of my out-of-pocket expenses?
This depends on the insurance you have, but YES, most NON-Medicare patients can send “self-claims” to their insurance company for their treatments at our clinic. We have partnered with Reimbusify to provide a unique service for our patients to submit Out-of-Network (OON) claims in less than a minute. We did this so that you can focus on getting the treatment that you need rather than spending your time and money on submitting self-claims. In addition, you can click here to file your claim FREE for this practice.
The amount of reimbursement or application towards your deductible is completely dependent on your insurance plan. If you call your insurance company to inquire about what you can expect to receive, you should ask about reimbursement for “out-of-network Physical Therapy” expenses sent in via self-claims.
Medicare Beneficiaries: The US government has some interesting laws that control where Medicare beneficiaries can spend their healthcare dollar and persuade healthcare providers to enroll in their system. Because we are not Participating Medicare Providers, we can only accept Medicare beneficiaries as patients when the patient does not want Medicare billed for any PT services. This request to not involve Medicare in payment must be made up front by the patient and be made of the patient’s own free will.
In other words, if you’re a Medicare beneficiary and are adamant about seeing us for your care even though we are not participating Medicare providers, we can help … However, the only way we can provide you with PT services is when you truly don’t want Medicare involved and you ask up front that Medicare not be billed or involved in your physical therapy care.
If you do want to use your Medicare benefits for physical therapy, we cannot provide you with treatment at our clinic but we can help you find a good Medicare provider in your area.
Do I have to have a “PT referral” to start treatment?
New regulations allow Physical Therapist to evaluate your injury without a referral and provide treatment for a limited number of days if the PT meets the following criteria:
In order to provide treatment without a script/referral to a patient for ten consecutive business days, the PT must possess a doctoral degree in physical therapy or have completed thirty (30) continuing competence units in differential diagnosis. If a PT with a doctoral degree has completed a fellowship or residency, the number increases to 15 consecutive business days.
All patients without a referral must sign a disclosure form prior to treatment. At Total Potential all our PT’s can with start treatment without a referral. A referral can come from an MD, DO, Physician’s Assistant, Advanced Nurse Practitioner, Dentist, Podiatrist, or a Chiropractor… and it can come from any of these professionals licensed anywhere in the United States.
This has nothing to do with insurance regulations or reimbursement, and it still applies to our clinic even though were are not in-network with insurances.
If obtaining a PT Referral is proving difficult, please let us know as soon as possible and we can suggest a variety of options for getting one quickly and easily.
Choose an option below to get started.