Insurance:

Understanding Insurance Coverage
Do you know what physical therapy services your health insurance plan covers?

Most people don't know what their benefits and choices are. We believe that most people do not get the correct and full benefit information from their doctor's office or insurance company. Hopefully we can help you with making the right discussions for your physical therapy needs and care. Remember, this information is only to give you general information about insurances in the state of Delaware. Always call your insurance company to get specific information about your insurance plan and your benefits.

How do I know what my physical therapy coverage is?
The first thing to determine is what kind of plan you have. There are several options e.g. Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) or Point of Service plan (POS). Sometimes you can find this information on your card but you can always find it in your information booklet you received from them or your benefits coordinator at work. What kind of plan you have determines what kind of options you have in choosing your physical therapy provider.

HMO Insurance
With HMO's you have to go to providers in the insurance network. You should have received a book with a listing of providers who signed a contract with your insurance company. With an HMO you are only allowed to go to providers that are listed in that book or on their web-side. Other providers will not be reimbursed for the services provided and you will be responsible for the charges and will receive a bill.

PPO or POS Insurance
With a PPO and POS plan you have a choice to go in or out of the network. You can go to the providers in the book and receive a higher level of coverage or go to providers out of the network. When you go out of the network your benefits are different from in network and you might be responsible for a yearly deductible, limitations in percentage of coverage, the difference between the bill and the insurance coverage and other restrictions. The best way to find out what your benefits are is to call the number on the back of the card and ask specifically for your in and out of network benefits for physical therapy.

Medicare
Medicare patients can go to any provider that has a contract with Medicare. Most providers have contracts with Medicare and the easiest way to find out is to call the provider and ask them if they participate in Medicare. Remember that Medicare only covers 80% of the cost of physical therapy. Most people have secondary or supplemental insurance to cover the 20%. If you don't have secondary insurance ask the provider how much the 20% will be per session.

Workmen's Compensation
When your injury is related to work and you have a workmen's compensation claim and number, you can go to any licensed physical therapist. You can go where ever you want to go as long as the service is provided by a licensed physical therapist and/or physical therapist assistant. Your bills are fully covered for the physical therapy provided and the provider is not allowed to bill you the difference between the amount billed and the amount paid by your insurance company.

MVA or No Fault Insurance
When you injury is related to a motor vehicle accident and you have a claim number, you can again go to any licensed physical therapist. You can go where ever you want to go as long as the service is provided by a licensed physical therapist and/or physical therapist assistant. Your bills are fully covered for the physical therapy provided and the provider is not allowed to bill you for the difference between the amount billed and the amount paid by your insurance company.

If you have a special situation or still have questions about your coverage you can always call the provider. We, at Manual Orthopaedic Physiotherapy, will be more than happy to help you find out what your benefits are. And if we can not see you we might be able to recommend somebody in your network or refer you back to your physician.

What other option do I have?
One option you should strongly consider if your insurance doesn't cover the physical therapy you need is to pay for it yourself. Physical therapy offers a wide range of benefits-from preventing injury to restoring function- and PT's offer expertise in such areas as safe exercise and user friendly home and workplace design. In Delaware you don't need a doctor's approval to see a physical therapist if you are paying out of pocket. This will speed up the time before you can be seen by the therapist. A lot of our patients use their medical spending account (MSA) for their deductibles or payment out of pocket and some patients are able to use it as a tax deduction.

Also remember, a lot of people pay out of pocket for vitamins, massages, chiropractic care, gym memberships and yoga. Why not physical therapy-one of the best things you can do for your personal wellness?

Why is MOP only in a few networks and not like the other big practices in all of them?
We are dedicated to providing the best physical therapy care in the greater Wilmington area. You will receive one on one care which means when our therapists are seeing you they only treat you and not multiple people at the same time. We believe that we can only provide high quality, personalized care to one person at the time. Our care is personal, specific for your pathology and your symptoms at that day and we will focus on getting you better as soon as possible.

Most insurances pay at a lower rate if you sign a contract with them and become an in network provider. They do this because they will tell you that you will see more patients if you are an in network provider and if you see more patients per hour at a lower rate you still can make money. We do not believe in volume but in quality. We rather spend quality time with you and focus on you to get you better as soon as possible than see more patients and jeopardize our quality. We also want to give you the best physical therapy treatment there is and not be ruled by insurance companies.

We think we should, together with your physician, make the decisions about your physical therapy care. We don't think your insurance company should be involved in medical decisions or care issues. We will work with your physician to give you the best care available.
In our clinic you will be seen every visit by a physical therapist who is a specialist in their field. Our therapists are experienced, highly respected clinicians who are trained and continue their education on a regular basis to be up to date with the latest advances in physical therapy.