Monday, April 14, 2014

A Brief Guide to Understanding Health Insurance Jargon

Wholeness In Motion is proud to have an in house billing department. We accept a variety of insurance plans including medicare, workman's compensation, and motor vehicle accident claims.  Here is a simple guide to help make your insurance and billing experience with us as smooth and effortless as possible.

The Basics: Common Types of Insurances 
1) Personal Health Insurance (PHI): This is insurance you get through your employer or purchase on your own. It's commonly used for routine health care. Some PHI's require a referral or prior authorization from your primary care provider/doctor. Most insurances cover physical therapy benefits ranging from an average of 20, 30, or 60 visits per year.
Here are the Participating Providers for Wholeness In Motion:
*Blue Cross/Blue Shield
*MODA (specifically the ODS + network)

But wait! If you don't have a PHI with one of these providers, you may have benefits available to see us through your out of network (OON) benefits. This could actually be a very cost effective choice for you. 

2) Motor Vehicle Accident (MVA): When you are in a MVA your auto insurance is billed which includes health care costs in the event of an accident. Most MVA claims do not require a referral for physical therapy services. Remember to fill out a PIP application, received a claim number from the auto insurance, and of course know the date of the injury prior to your first appointment with us. In the State of Oregon you have 1 year to receive treatment from the date of injury or you can receive $15,000 (whichever comes first). 

3) Cash/Self Pay: Clients that are uninsured or don't want their insurance billed due to high deductibles or other reasons often pay cash.

4) Workman's Compensation (WC): A workman's compensation claim is usually filed when you are hurt while working on the job. Wholeness in Motion does take WC claims depending on their claim status and authorizations/referrals. You are going to want to know if your claim is open vs. closed. If it is open then it is accepted by the WC insurance carrier and you are/can actively receive treatment. 

5) Medicare: We do accept Medicare. Remember to get a referral from your healthcare provider.

What to do before scheduling your visit with Wholeness In Motion?
 It's very important to be familiar with the benefits of your insurance plan prior to scheduling your appointment. The billing department offers insurance verification as a customer service courtesy, but it is always helpful that you know what coverage you have. 

Many thanks to our billing staff, Elly and Joy, who greatly help all of our clients with their insurance and billing questions on a daily basis.