There's nothing more confusing than figuring out insurance benefits; in network versus out of network, medicare benefits, secondary insurance plans, co-pays, etc., can all make your head spin when you're trying to figure out how to plan your physical therapy recovery. Insurance should be the last thing you are worried about when you are in the midst of your recovery plan and we understand that, which is why we go above and beyond to make your experience with us as stress free and accessible as possible. We do everything we can to work with your insurance plans, even if you don't think we are "in-network" or if it seems like your Medicare coverage might not be enough.
Here are a few key points to understand when you start making decisions regarding your physical therapy recovery in New York City.
In Network Vs. Out of Network Providers
In network providers are insurance companies that have made deals with specific doctors when it comes to billing, making it easier for you to make choices when it comes to health care coverage because you know what your co-pay will be and what your exact coverage is. Working in network is beneficial to both healthcare providers and patients since there is already an agreement on how much of a procedure will be covered.
It is also a great way to find healthcare providers since there is a history of trust between the insurance provider and the healthcare provider. In both our Manhattan and Westchester offices we are in network providers for Medicare, Oxford, and United Health Care. We also take certain plans with Aetna, Cigna, and Blue Cross Blue Shield.
Out of network providers are insurance companies that have not specified coverage amounts with a healthcare provider, but this doesn't mean the two don't have an understanding or relationship of some kind. It's worth it to work with an out of network provider if you want to take on a health plan with a specific practitioner or group. Remember, this is your health and the quality of the rest of your life; it's worth it to do the digging necessary to see if you can work towards recovery with people you trust in facilities that are going to offer you the best healing tools possible.
Sometimes out of network coverage can be even better than what you'll find with your in network providers. This might mean the coverage provided by your out of network provider could be high enough to waive any co-pay on your part. You won't know until you reach out and ask and a few minutes of your time could be well worth it.
First of all, Sloane Stecker Physical Therapy is proud and happy to work with Medicare patients and we have been doing so for years now. Medicare covers patients 65 years and up (certain exceptions can be made for earlier coverage) and with retiring baby boomers heading to the city in droves we believe it is important to keep our doors open to the expanding community of Medicare patients in the Upper West Side and Irvington.
Supplemental Insurance Benefits
Here's where your insurance coverage can get really complicated. You often have more than one insurance provider, your primary payer and your secondary payer. Say you have Medicare as a primary provider with a Blue Cross Blue Shield supplemental. This means your bills will first go to Medicare for bill coverage and then whatever Medicare doesn't cover will go to Blue Cross Blue Shield, your secondary (or supplemental) insurance payer. It might be that your primary coverage isn't in our network but your supplemental insurance is...or both might be out of network but we might still be able to work with you anyhow!
If after reading this you still aren't clear on your insurance benefits and if we will be able to work with you, give us a call or shoot us an email. It's our job to know these rules like the back of our hand and we can do the digging for you. In most cases we can have your coverage figured out in less then ten minutes.