AthletePlus.net - Physical Therapy & Sports Performance Training
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the Suckerfish
Office manager will take your
paperwork if filled out beforehand or give you a clipboard with the
forms to fill out. Evaluation will consist of questions about
your medical history, current and past injuries, activities that make
the symptoms worse or better, effect on activities of daily living, and
goals with physical therapy. An evaluation then occurs to
assess strength, range of motion, special tests, etc. to assess the
injury. Depending on the injury, neurological screening and
other tests may occur. Depending on time, treatment may begin
on the first day. Your therapist will then discuss the findings and a
plan of care. You may ask questions during this time as we
will discuss number of treatments per week, goals, home exercise
programs, and discharge planning.
What do I need to bring to the
first visit? We ask that you arrive about 15
minutes early before your first visit in order complete
paperwork. You may download the paperwork if you want to fill
it out and bring to the clinic to save time.
Present
Prescription from your MD usually on a small sheet of paper
Present
your insurance card and drivers license for us to make a
copy. If you are covered by workers comp, bring your claim
number and your case manager's contact information. If you are covered
by auto insurance, make sure you bring this information.
Wear
or
bring loose fitting clothing to allow the therapist to access the body
part that is injured
Where are you
located? See the map
here for our
convenient location. Since
sitting and driving often
aggravate orthopedic problems such as back and neck injuries, there
should be a very good reason for you to drive a long distance for
physical therapy.
How long will
each treatment
last? Each treatment will last 30
minutes to an hour, depending on your diagnosis and treatment needed.
How many
visits will I need? That will depend on your
diagnosis, evaluation, plan of care, and response to treatment. Your
doctor or insurance also may dictate the number of visits.
Why is
physical therapy a good
choice? Physical therapists (PTs) are
health care professionals who diagnose and treat individuals of all
ages, from newborns to the very oldest, who have medical problems or
other health-related conditions that limit their abilities to move and
perform functional activities in their daily lives.
PTs examine each individual and
develop a plan using treatment techniques to promote the ability to
move, reduce pain, restore function, and prevent disability. In
addition, PTs work with individuals to prevent the loss of mobility
before it occurs by developing fitness- and wellness-oriented programs
for healthier and more active lifestyles.
Physical therapists provide care
for people in a variety of settings, including hospitals, private
practices, outpatient clinics, home health agencies, schools, sports
and fitness facilities, work settings, and nursing homes. State
licensure is required in each state in which a physical therapist
practices.
All PTs must receive a graduate
degree from an accredited physical therapist program before taking the
national licensure examination that allows them to practice. The
majority of programs offer the doctor of physical therapy (DPT) degree.
What do
physical therapists do? Physical therapists seek to
restore function, whether it is an adult to return to work, an athlete
to return to his or her sport, or a senior adult to be able perform
gardening for example. In outpatient therapy, our goal is to
get to the source of the problem, attempt to solve the problem and get
the patient independent in his or her home exercise program to prevent
the injury from occurring again. They also restore,
maintain, and promote overall fitness and health
Why should I
go to physical
therapy?
Physical
therapists are experts in how the musculoskeletal and
neuromuscular systems function.
Physical
therapist services are cost-effective. Early physical therapy
intervention prevents more costly treatment later, can result in a
faster recovery, and reduces costs associated with lost time from work.
Patients
pay less when they have direct access to physical therapy
services. However, there can be a temptation under managed care to
terminate services prematurely. A study conducted to determine whether
direct access to physical therapy services was cost-effective found
that patients who went directly to a physical therapist had fewer
episodes of care, and services were ultimately less costly.
When Do You
Need a Physical
Therapist? The following list contains some
of the most common reasons to see a physical therapist and those
conditions treated at AthletePlus.
Back
conditions
Knee
problems
Shoulder/arm
conditions
Neck
conditions
Sprains
and muscle strains
Ankle/foot
problems
Carpal
tunnel syndrome,
hand/wrist problems
Hip
fracture
Post-surgical
rehabilitation
Rehabilitation
after a serious injury (eg, broken bones, head injury)
Stroke
rehabilitation
Problems
with balance
AthletePlus
will electronically
or manually send your billed charges to your insurance company.
Disabilities
in newborns
Why should I
choose a private
practice physical therapist? Many physicians own
their own therapy department. While there are some good
therapists working for physicians, many studies have demonstrated
disadvantages to the patient. One study found
physician-owned clinics treat patients for 50 percent more visits than
do independent clinics (1) Another study demonstrated that
self-referral increases the cost of medical care covered by workers'
compensation for each of the three types of service studied physical
therapy, psychiatric evaluation, and magnetic resonance imaging
(MRI)--. (2) Still one more study indicated that licensed and
non-licensed therapy providers spent less time with each patient in
physician owned clinics and physical therapy assistants were
substituted for physical therapists. (3) Physicians will claim they
work better with therapist on site and a better continuum of
care. Private practice therapists are very qualified and
always follow protocols set by orthopedic physicians.
Mitchell
JM, Sass
TR. J Health
Econ. 1995 Aug;14(3):263-89. Physician ownership
of ancillary services: indirect demand inducement or quality assurance?
Swedlow
A, Johnson
G, Smithline N, Milstein A.N
Engl J Med. 1992 Nov
19;327(21):1502-6. Increased costs and rates of use in the
California workers' compensation system as a result of self-referral by
physicians.
Who pays for
the treatment? AthletePlus accepts and will
file most insurances, but a copay or co-insurance may be required on
your part. Some patients elect to be treated on a cash basis. Speak
with our office manager for details on insurance. Who will see
me? A licensed physical therapist
will evaluate you and we make every attempt for you to see the same
therapist each treatment to develop a relationship and continuum of
care. Many clinics will have an unlicensed aide do all the
treatment each session. What if need
to cancel my
therapy appointment? If possible, please allow 24
notice if you can not make your appointment. There are
usually other patients that could have used that appointment time. If
you need to cancel or re-schedule, call 751-8437. Is it
important to come to every
visit of physical therapy? AthletePlus will complete a care
plan that requires attendance for an optimal recovery. One
reason many patients do not improve is because of inconsistent
attendance patterns or many cancels. Is physical
therapy painful? Because we attempt to find the
root cause of the problem, the initial evaluation may cause soreness.
But pain relief measures called modalities or hands-on techniques are
usually used to decrease the soreness from the first visit. Exercises should not cause your
initial pain to worsen. If pain gets worse and worse during
exercises, we ask the patient to perform the exercises in a smaller
range of motion or with less weight. If the pain continues to worsen
with each repetition, the patient should stop and tell his or her
therapist. In some cases where range of motion is vital, such
as a frozen shoulder or stiff knee, pain may be caused. How does the
billing process
work? AthletePlus will electronically
or manually send your billed charges to your insurance company. We will submit
claims on your behalf to your insurance company. For billing questions, amanda@athleteplus.net or call 751-8437. Can I go to
any physical therapy
clinic? Yes, you have the right to
choose any therapy clinic, even if you choose not to go to the
therapist at your physician’s office. Just ask your
doctor for a referral to the clinic of your choosing. Can I go
directly to my physical
therapist? In Arkansas, we have direct
access. This means that you may go to a physical therapist directly for
an initial consult. Insurance does not pay for this service, so the
patient will be sent to a physician if needed. A patient may
pay cash or credit card for therapy treatment without a physician
referral.
Where should
I go for physical
therapy or how should I choose a physical therapist?Is the therapist experienced in
treating your injury? Do not be afraid to call the clinic and
speak to the therapist directly. Our number is 751-8437. Is the therapist qualified? See
our physical therapist bio for qualifications. Care should include a variety of
techniques which might include hands-on techniques, soft tissue work,
therapeutic exercises and in some cases heat, cold, electrical
stimulation or ultrasound. Make
sure that you receive
physical therapy from a licensed physical therapist. Physical
therapists are professional health care providers who are licensed by
the state in which they practice. If you are receiving physical therapy
from a physical therapist assistant, be sure that he or she is
supervised by a licensed physical therapist.<li><a href="PTFAQ.shtml">PATIENT QUESTIONS </a></li> Keep in mind that your insurance
policy may require a visit to the primary care physician first or limit
your access to only preferred providers. Your physician may
refer you for physical therapy that is to be provided in his or her
office or to a facility in which he or she has a financial interest. If
either situation is the case, insist that your physical therapy be
provided by a licensed physical therapist. Will you take my insurance or
work with me if I need to be cash based patient? Some clinics will not take a
patient if they do not have the right insurance or an insurance that
will pay the clinic well. AthletePlus will allow payment
plans. Some policies require
co-payments for services and the co-payment will be dependent on if the
physical therapist is part of the insurer's provider network. You will
also have to meet your deductible.. Do you have
flexible hours? AthletePlus offers later
appointment times and even Saturday appointments if needed Do you have a
form to fill out
for feedback or patient satisfaction? You can send us feedback through
this form
What is your
privacy policy? Our privacy policy can be obtained at our office.
Do you have
any information on
insurance and how to get the best coverage? Physical Therapy & Your
Insurance: A Patient's Guide to Getting the Best Coverage
The best way to take care of
your health is to take an active role in your own health care. To do
this, you need to know about your options and your rights as a patient.
Patients across the country are becoming better educated and demanding
more and better options from their health insurance companies. The
right to physical therapist services is an important option, and it is
your right as a patient.
Federally qualified HMOs are
required to have physical therapy in their benefits packages.
In most states you may see a
physical therapist without a doctor's referral, but be sure to check
your health insurance plan to see if physical therapist services are
covered without a physician's referral.
What Can You
Do to Improve Your
Physical Therapy Coverage?
*
Talk with your employer/benefits manager. The employers who contract
and pay for employee health care plans often have the most influence
with insurers. Employers are interested in keeping their employees on
the job and their premiums low, so providers who can help employees
prevent injuries and avoid recurrence (as well as promote a healthy
lifestyle) have particular appeal to them. Arrange a meeting with your
human resources director or whoever is responsible for negotiating the
terms of the company's insurance plan.
*
Ask your human resources director or insurance company the following
questions to determine if your current benefits package gives you
access to appropriate physical therapy services:
1. Is your physical therapy
benefit "bundled" with those of other providers of care?Physical
therapy services should be listed separately in the benefit language so
that access to necessary services is not compromised.
2. Does the benefit language
permit access to physical therapists for each condition during the
year?Benefit language should permit treatment of more than one
condition in a calendar year (eg, ankle fracture in January and low
back injury in July).
3. Does the benefit language
permit access to physical therapists for each episode of care?A person
may require more than one episode of care for the same condition. For
example, someone with arthritis may receive physical therapy
intervention for knee weakness in an attempt to avoid surgery. While
this is often successful, some patients may still require surgery for
the knee condition (eg, total knee replacement), which may require
post-operative physical therapy treatment. The benefit language should
support each "episode of care."
4. Does the benefit language
ensure coverage that facilitates restoration of function?Benefit
language that restricts physical therapy care to a 60- or 90-day period
imposes an arbitrary limit on recovery. In determining an appropriate
physical therapy benefit that will allow an individual to return to his
or her previous level of function, benefit language should reflect the
normal amount of time that it takes to recover from an injury or from
surgery.
5. Does the benefit language
ensure coverage that promotes functional independence for those with
chronic conditions?Someone who has a chronic condition may need to be
seen periodically by a physical therapist. The physical therapist will
determine if the individual's home program, equipment, or adaptive
devices should be modified. (For instance, children requiring orthotic
devices will need modifications to those devices as they grow.) Benefit
language should ensure that someone with a chronic condition may
receive the kind of care that promotes personal safety and the greatest
degree of function possible.
*
Give the attached educational brochure to your human resources director.
*
Send the attached educational brochure to your insurance company and
ask for increased coverage of physical therapy care. Choosing a
Health Plan
Millions of Americans are
offered a choice of health plans through their employers, but the
question is —What makes a good health care plan? Here are
some things to consider when choosing a health plan.
*
Are you choosing a plan simply because it is the cheapest? This may not
be the best way to go. Some inexpensive plans have a high deductible
and no comprehensive coverage.
*
Is the plan accredited by the National Committee on Quality Assurance?
This is a good indicator of quality.
*
Are your current doctors and specialists in the plan? If not, make sure
you will be able to see a certain provider or specialist, such as a
physical therapist, without too much added expense and difficulty.
*
Is physical therapy coverage adequate?If you should have an injury or
illness requiring rehabilitation, you will need a plan that offers an
unlimited number of visits to a physical therapist or that allows for
the number of visits to be extended if needed.
*
Are there lifetime limits on benefits? If so, you could face a serious
financial crisis if you or a covered member of your family suffers a
major illness or injury.
*
Does the plan have an out-of-pocket maximum? In this case, once you
have paid a certain amount (usually several thousand dollars) the plan
would cover the rest.
*
How does the plan handle grievances and appeals? The procedure should
be simple, timely, and accessible.
*
Does the plan permit use of outside doctors, specialists, or hospitals?
Called "point-of-service" option, this would allow you to see a
provider, such as a physical therapist, who is not in your plan. There
may be an additional cost, but it may be worth it.
*
What is the plan's disenrollment rate? A high rate of members leaving
the plan annually may indicate customer dissatisfaction.
*
Can you help me with common insurance terms?
Navigating your way through
health insurance benefits can be a challenge. It is very important to
understand the terminology especially when deciding which benefits will
work for you and finding a plan that will best meet your needs. This
brief glossary will provide insight for some of the more common terms
when dealing with health insurance.
co-insurance: in
indemnity, the
monetary amount to be paid by the patient, usually expressed as a
percentage of charges.
co-payment: in
managed care, the
monetary amount to be paid by the patient, usually expressed in terms
of dollars. consumer driven health care (CDHC): refers to
health plans in which employees have personal health accounts such as a
health savings account, medical savings accounts or flexible spending
arrangement from which they pay medical expenses directly.
deductible: the
portion of
medical costs to be paid by the patient before insurance benefits
begin, usually expressed in dollars.
denial: refusal by
insurer to
reimburse services that have been rendered; can be for various reasons.
eligibility: the
process of
determining whether a patient qualifies for benefits, based on factors
such as enrollment date, pre-existing conditions, valid referrals, etc.
exclusions: services
that are
not covered by a plan.
flexible spending arrangements
(FSAs): an account that allows employees to use pre-tax
dollars to pay
for qualified medical expenses during the year. FSAs are usually funded
through voluntary salary reduction agreements with an employer.
gatekeeper: in
managed care, it
refers to the provider designated as one who directs an individual
patient's care. In practical terms, it is the one who refers patients
to specialists and/or sub-specialists for care.
health maintenance organization
(HMO): a form of managed care in which you receive your
care from
participating providers.
health savings account (HSA):
a
savings product that serves as an alternative to traditional health
insurance. HSAs enable you to pay for current health expenses and save
for future qualified medical and retiree health expenses on a tax-free
basis.
managed care: a
method of
providing health care, in which the insurer and/or employer
(policyholder) maintain some level of control over costs and
utilization by various means. Typically refers to HMOs and PPOs.
member: a term used
to describe
a person who is enrolled in an insurance plan; the term is used most
frequently in managed care.
open enrollment: a
set time of
year when you can enroll in health insurance or change from one plan to
another without benefit of a qualifying evening.
out-of-pocket: money
the
patient's pays toward the cost of health care services.
payer: the party who
actually
makes payment for services under the insurance coverage policy. In the
majority of cases, the payer is the same as the insurer. But, as in the
case of very large self-insured employers, the payer is a separate
entity under contract to handle the administration of the insurance
policy.
policyholder:
purchaser of an
insurance policy; in group health insurance, this is usually the
employer who purchases policy coverage for its employees.
preferred provider organization
(PPO): a form of managed care in which the member has more
flexibility
in choosing physicians and other providers. The member can see both
participating and non-participating providers. There is a greater
out-of-pocket expense if member sees non-participating providers.
premium: the cost of
an
insurance plan shared by employer and employee.
provider: one who
delivers
health care services within the scope of a professional license.
reimbursement:
refers to the
payment by the patient (first-party) or insurer (third-party), to the
health care provider, for services rendered.
More on Physical Therapy
Physical therapists are experts
in "the science of healing and the art of caring." This is what that
means: The Science of Healing.
Patients and physicians are
demanding the talents of physical therapists for conservative
management of a wide variety of conditions. In many cases, patients are
being sent to physical therapy instead of surgery.
Physical therapists help people
with orthopedic conditions such as low back pain or osteoporosis; joint
and soft tissue injuries such as fractures and dislocations; neurologic
conditions such as stroke, traumatic brain injury, or Parkinson's
disease; connective tissue injuries such as burns or wounds;
cardiopulmonary and circulatory conditions such as congestive heart
failure and chronic obstructive pulmonary disease; and workplace
injuries including repetitive stress disorders and sports injuries.
Physical therapists practice in
a variety of settings, including hospitals, private practices,
outpatient clinics, home health agencies, schools, sports and fitness
facilities, work settings, and nursing homes.
Some physical therapists seek
advanced certification in a clinical specialty, such as orthopedic,
neurologic, cardiovascular and pulmonary, pediatric, geriatric, sports
physical therapy, or electrophysiological testing and measurement. The Art of Caring.
The individualized, "hands on"
approach that characterizes physical therapist care is highly valued by
patients. When a physical therapist sees a patient for the first time,
he or she examines that individual and develops a plan of care that
promotes the ability to move, reduces pain, restores function, and
prevents disability. The physical therapist and the patient then work
side-by-side to make sure that the goals of the treatment plan are met.
Therapeutic exercise and
functional training are the cornerstones of physical therapist
treatment. Depending on the particular needs of a patient, physical
therapists may "manipulate" a joint (that is, perform certain types of
passive movements at the end of the patient's range of motion) or
massage a muscle to promote proper movement and function. Physical
therapists may use other techniques such as electrotherapy, ultrasound
(high-frequency waves that produce heat), hot packs, and ice in
addition to other treatments when appropriate.
Physical therapists will also
work with individuals to prevent loss of mobility by developing
fitness- and wellness-oriented programs for healthier and more active
lifestyles.