Frequently Asked Questions
Here are some of the questions people ask when they hear that Phileo Health is a DIRECT-PAY practice:
Why don't you accept insurance?
There are many motivating factors in my desire to provide a direct-pay physical therapy business. The layers of brokenness in our current health care system are too complex to dissect, but a few stand out as major pitfalls that Phileo Health seeks to avoid. First of all, PT services have become cost-prohibitive for many people. One hour of physical therapy in a typical PT clinic or hospital in the Chippewa Valley is billed to insurance for $220-360. This may even include the time when you are exercising on your own, lying alone on an e-stim unit, or being seen by a tech or PT aide. Some clinics offer a cash discount, but, at best, you will likely pay $140/hour or more out-of-pocket for the cash rate or towards your deductible. If you are seen for thirty to sixty-minute visits, two or three times per week, the cost adds up fast! If you have great insurance, this may not be a problem for you, but if you are working towards a high deductible, have steep co-pays, or have limited insurance benefits for PT, you are more likely to forego physical therapy due to cost, seek out a less-qualified practitioner, or spend a very long time paying off your therapy bill. Our hope is to make PT affordable by setting a reasonable price structure and offering excellent, evidence-based care that gets you better in far fewer visits—more bang for your buck, Baby!
In addition, ongoing changes to our health care system (cuts in reimbursement given from insurance companies to physical therapy clinics) make it difficult for private practice therapy clinics to survive. In order to do so, they often need to make changes in how they deliver services, by decreasing the time spent with the patient at each visit and/or delegating aspects of treatment to assistants and aides. Having thoroughly enjoyed working in the private practice setting for most of our careers, we mourn these changes. We believe that we can deliver a higher quality of care than the "survival strategies" allow. This lead to our desire to forge out on our own, trusting clients to spend their own resources where they find value.
Can I submit my physical therapy receipts to my insurance company or HSA on my own?
Yes! IF your injury or diagnosis causes you to have an impairment in your daily function and your insurance would typically cover physical therapy for that diagnosis, you can seek reimbursement from your insurance company or HSA. However, you must do this on your own. (Remember, that's how we are able to keep our costs down). We will provide a detailed receipt with your diagnosis code / ICD-10 code(s), as well as the CPT codes for the procedures used in your treatment. Your insurance company may have a special form for you to fill out for reimbursement for services received from "Out-of-Network" providers. Since Phileo Health Network does not contract with any insurance companies, we are considered an "Out-of-Network" provider.
Some injuries and conditions, while bothersome to patients, really do not cause functional impairments in one's daily life. It is important that you understand your insurance company's policies in terms of what is covered and what is not. For example, Wellness and "Performance Enhancement" are outside the scope of what most third-party payers are willing to cover.
Can I get Therapeutic Massage reimbursed from my HSA?
Possibly, but integrity is crucial here. Your HSA is subject to scrutiny by the IRS so it is always best to be conservative and aboveboard. We can discuss this at your appointment to make sure your "need" is legitimate and there is no abuse of the system. That said, your HSA money is money that YOU have set aside for your health, and therapeutic massage can greatly aide in your health and wellness. Here is what to folks at Massage Envy (a national chain of massage therapy providers) have to say abut HSA eligibility:
"Is My Massage Eligible?" "Massage therapy can be a qualified medical expense," Curry says, as long as a physician recommends it with a written prescription. The IRS ruling states that medical care expenses must be primarily to alleviate or prevent a physical or mental ailment. Examples of illnesses that qualify include carpal tunnel syndrome, stress, back pain, arthritis, diabetes, hypertension, fibromyalgia, chronic fatigue, anxiety, depression and pain management.
First Steps: If you suffer from one of the above conditions (and who isn't stressed?), all you need to do to set up massage as a qualifying expense is pay a visit to your medical practitioner. Let him or her know that you have an FSA or HSA and you'd like to use some of your funds toward massage for treatment or prevention of your condition.
Your physician will need to provide three pieces of information on the prescription:
1. Medical necessity: why you need massage therapy (example: to relieve back pain)
2. Frequency: number of sessions per month (example: minimum of two sessions per month)
3. Duration: length of treatment (example: 12 months)
Once you've obtained the prescription, file it away in case you are ever asked to back up the expense. It's not necessary to bring the prescription to Massage Envy, but you should bring your FlexCard (if you have one) to pay for your next visit. If you don't have a FlexCard, simply pay for our massages and turn in your receipts for reimbursement. Note that you can't include tips or pay for your entire membership upfront.
We agree with this policy. If your physician is willing to order therapeutic massage for you to manage your condition, and if you feel comfortable that you could defend yourself to the IRS if you are ever questioned, then go ahead and submit your massage receipts to your HSA. We do accept credit cards so using your FlexCard should work as well.
I have Medicare. Can I still come to Phileo Health?
The short answer: It depends.
The long answer: Medicare aims to cover physical therapy services through licensed physical therapists who have a Provider Identification Number (PIN). We are licensed providers with PINs and have treated Medicare patients for years. Unfortunately, Medicare does NOT allow their enrollees (which is anyone 65 years and older) to pay for their own physical therapy services. That is, enrollees MUST use their Medicare benefits when receiving physical therapy. Since Phileo Health is a direct-pay practice, NO insurances are accepted, including Medicare. That means that we cannot provide services to Medicare or Medicaid recipients and charge for it.
There are certain services that Medicare will not pay for in a "regular" clinic, however, that you can purchase with your own dollars. Any service that is for WELLNESS or PREVENTION is within your rights to purchase from a qualified provider. For example, you can pay for physical therapy services aimed at improving your golf game. Medicare does not consider this reasonable and necessary medical care as golfing is not required for you to be "functional" in your daily life. If it is important to you, however, to regain that last ten degrees of range of motion so that your backswing is on target, you can pay for physical therapy under our Wellness Services. Similarly, you can "buy" a therapeutic massage for relaxation or relief of tension in your muscles. If, however, you have a condition which truly limits your function on a daily basis (i.e. you struggle to dress, bathe, transfer, walk, care for yourself or get out in the community because of your pain or impairment), you need to obtain your physical therapy services at another clinic.
Medicare's limits on physical therapists "opting out" of Medicare is currently being challenged by physical therapy lobbying groups, so the situation may change. Your right to obtain your physical therapy service where you want is, in our opinion, something that should be your choice. We LOVE working with the geriatric population, and sincerely hope this policy changes as healthcare reform evolves. In the meantime, we are committed to maintaining professional integrity, even in the presence of rules that don't make sense to us. Therefore, we would be happy to refer you to some of our colleagues in the area who provide excellent care and who submit those charges to Medicare.
If you have Medicare coverage but strongly desire services at Phileo Health Network, and have questions about this policy and/or the appropriateness of direct-pay physical therapy services for you, please call Jessie at 715-271-0388 to talk through your circumstances.
When and how do I pay?
All payment for the care you receive is due at the time of service. Cash, check, HSA cards, debit cards, and credit cards are accepted.
Do you keep a medical record?
Yes! Every patient has an electronic medical record, and records are stored in compliance with legal standards (seven years). You have a right to view your medical record at any time, and you can request copies as needed. You will be given the opportunity to read our full HIPPA policy, including your rights in terms of your medical information, at your initial visit and by request any other time.
What can I expect at my first visit?
Please come to your first visit with your completed medical history form and other paperwork. This paperwork will be e-mailed or mailed to you prior to your visit, or you can come fifteen minutes early to fill it out. If seeing Jessie or Curt, you can expect a PT screen at minimum, even for a "wellness massage." We will review your history and then check your range of motion, strength, balance and neurologic system. If you are coming for physical therapy, you can expect a more extensive evaluation prior to commencing treatment. We will discuss the findings and your goals, and we will establish a treatment plan. Wear comfortable clothing and be ready to move!