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How to Navigate Your Medical Insurance and Physical Therapy Treatment

Navigate your insurance

Insurance is a challenging industry to understand, whether its life insurance, personal insurance, or medical insurance, and sometimes the concepts are difficult to grasp. The insurance industry is always changing, and the United States government is implementing new laws and amendments. This is especially true when it comes to Obama Care and understanding your medical insurance policy.

One of the best ways to understand your medical insurance company and the coverage you have, is to educate yourself. The internet is full of information that breaks down insurance lingo into layman’s terms so that average citizens can comprehend their coverage and benefits. Another way that you can educate yourself about your coverage and how to understand your medical insurance company is to call them with your questions. More often than not, the customer service representatives are knowledgeable and can help clarify information for you. Billing is another story, but sometimes the insurance companies can be reasonable. If they don’t lower the charges on your bill, at least you may understand what the costs mean and how the billing process works.

It is important to understand the process by which the insurance company operates regarding your care as well. Unfortunately, most medical insurance companies regulate a patient’s care by enforcing guidelines that your doctor must follow before you receive the care that he thinks is best for you. For example, your physician has prescribed physical therapy for you because you’re experiencing knee pain. But, before you can start the physical therapy treatment, you must have an X-ray first. Then, if the X-ray results do not show an injury to justify the prescribed treatment, you will be required to get an MRI. Then, if the MRI results come back with inflammation or another ailment, the insurance company will approve your physical therapy treatment. Your doctor sends you on a little goose chase because he must follow the insurance company’s guidelines. Why does the insurance company do this? It’s all about money. The tests, the X-ray and MRI, are much cheaper than having to pay for a few months of physical therapy treatment for a patient. Your insurance company also requires these tests because they want to make sure that your doctor is diagnosing you accurately and that the treatment follows suit.

If you and your physician have followed all the required guidelines and the insurance company still refuses treatment, ask him to call the insurance company on your behalf. In the meantime, make a call to the medical insurance company yourself and advocate for the care that you need. However, your doctor can be a positive advocate for you and enlighten the insurance company of your condition and the treatment that he’s recommending to you. The insurance company may be more inclined to listen to him simply because he’s the physician.

You may want to ask your insurance company the following questions about your physical therapy treatment:
• Does my insurance company cover physical therapy?
• How do I know which physical therapist participates in my medical insurance?
• What if my insurance company only covers part of the services that the physical therapist provides?
• What is my financial obligation for my physical therapy program?

Medical insurance can be intimidating and difficult to digest. But knowledge is power and the more you educate yourself and become familiar with the terms that they use, the more you will understand your coverage. Understanding the terms will also help you to know how to communicate with your customer service representative so that your questions are answered. To learn about key vocabulary words that are common in the medical insurance industry, read this article by the Student Health Care Center, University of Florida’s website (http://shcc.ufl.edu/fees-and-insurance/health-insurance-information/understanding-your-insurance/).

Health insurance typically covers most forms of physical therapy, though coverage varies with each plan. RPI is a provider for most health insurance companies, and our office staff will be happy to help you verify that your insurance covers your treatment.