1. Co-payments:

   Medicare is an 80/20 plan, you are responsible for 20%. And, if you have a secondary insurance, the 20% should be covered.

   Aetna MC advantage is a different program and you will be responsible for a co-payment. Please call and know that amount; each plan is different.

2. Deductibles:

   Medicare: There is a $257.00 deductible each year that you must pay before Medicare will reimburse Bodylogic for your therapy. Unless you have a secondary insurance plan, specifically plan F (rare), you are responsible for that amount. You will need to pay this amount at the time of service. IF you have seen other medical practitioner(s) (your primary care physician for example), you may have already paid toward the deductible. Regardless, just know that you will be paying 257.00 to your first practitioners of the year, unless your secondary covers it.

You are also responsible for what your insurance company does not pay. Insurance companies will not pay for Massage, Dry Needling, Theraband, Exercise classes, Bracing, Taping, and many modalities. For Bodylogic, that consists of any treatment that falls under Medical Bodywork or Medical Wellness.

1. Medicare for Physical Therapy can only be used if you have functional deficits. If you can not turn your head to drive, can’t stand long enough to cook, can’t walk essential distances, can’t take the trash out, can’t sleep, etc. It can not be used for personal training or massage techniques. We have two other programs for this type of therapy—Medical Wellness and Medical Bodywork.

2. I do not exceed the $3000 threshold for Medicare in a calendar year. This comes out to about 23-26 PT appointments for the year, depending on what the charges are during treatment. It is important to conserve appointments in case there is an issue later in the year. For more chronic issues, for scheduling purposes, I typically see patients for 4-6 weeks for one round of therapy, if that is needed.

3. If you have reached a point in your therapy where you are no longer getting better, or if you are getting worse, or if you have gotten to a point with your therapy where you can manage on your own (doing your exercises on your own), Medicare will not continue to pay for your PT treatment. You will need to follow up with your Medical Doctor for next steps. Their terms are, ‘you have reached your maximum benefit’.

4. Lastly, Medicare can not be used one time per week (they don’t deem that medically necessary) and you can not utilize Medicare intermittently. An example of that is when you have a pain in your neck and you come in 1 time and then 5 weeks later, you do the same thing. Medicare would expect that you go see a massage therapist or chiropractor, or………

Medicare can be a bit harsh at times, but we have to follow the rules. Often patients will do a round of therapy and then pay out of pocket for the additional care that they feel would be helpful. If we over utilize Medicare, and if Bodylogic were to be audited, money will have to be paid back for the care that they deemed un-necessary, and that cost will come back to you.

I like to explain that it looks good to Medicare if you come in with your doctor referral, get evaluated, and do 2 times per week for 4-6 weeks, and tapering down as we go. If you get better before that, we can be done. If it needs to go beyond that, there are risks. Even if you MD has asked for 10 weeks of therapy. It certainly is complicated and even frustrating for all.

I offer 1 hour of treatment. That includes transition times, changing clothes, scheduling etc. Medicare only pays for 53 minutes of treatment in one session. So, the more of that you have done when you get here (scheduling, appropriate clothing etc), the more time for treatment. Remember that you can do all of your scheduling and maintaining a presence on the schedule at Bodylogicnc.com.

You can submit a claim for reimbursement for insurance plans that I am NOT IN-NETWORK with, and I will provide you with paperwork with insurance codes to accompany your claim. Currently, I am not in network with Blue Cross and Humana. My patients who do this, have reported that it is not challenging to be reimbursed.

HSA cards can be used for the cost of Physical Therapy care, Medical Wellness, and Medical Bodywork. Be sure to check with your plan for verification of coverage.

Some would say that his is an obvious answer, but I feel its important to address.

1. I don’t get reimbursed for my full rate.

2. It costs a significant amount to pay for a billing services. And, truthfully, they deserve it for the ‘red tape’ they have to sift through to get money for the work I have done.

3. It may take 2 -12 months to get the money for the services rendered.

4. The game of insurance feels like an unfair game. I never fully recover the money for the work I did, I never fully get paid for the time I put in administratively .

5. Insurance is a business that thrives on me not getting paid. Just not right!