Though your insurance company may allow many physical therapy visit per year, they usually also reserve the right to do a pre-check to ensure that the treatment you’ll be receiving will be medically necessary or able to make a positive change.
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or pre-certification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.
In and Out of Network
Some insurance companies have in-network providers, which means that they have pre-negotiated rates with those doctors or physical therapists, but insurance companies may also restrict the patient to the in-network providers. Some insurance providers that have in-network providers will also have out-of-network providers, although they may cover less of the expense of the treatment and have the patient pay the remainder of the bill.
Knowing your rights when it comes to your insurance
First, you should know that your insurance company is there to help you, you are not subject to their demands
You have a right to go out of network if your provider doesn’t have any in-network providers
If you are denied for authorization, you have your right to have your voice heard and to request more visits. If you are entitled to more visits than you were authorized for, you can speak to your insurance along with you physical therapists and doctor to be granted more visits
You are never locked into a healthcare provider, whether it is a doctor or a physical therapist. If you are unhappy with the care you are receiving, you are entitled to finding a care provider that you feel is good for you
For some more detailed info concerning healthcare laws in New York, please visit: http://www.dfs.ny.gov/consumer/hrights.htm
If you have any questions, give us a call at 718-258-3300 or contact us today!