What is physical therapy?
Physical Therapy (PT) is the treatment of disease, injury, deformity, or pain by physical methods such as mobilization of joints, therapeutic exercise / activities / massage, and electrotherapy. PT techniques promote mobility, reduce pain, restore function, and prevent disease.
What is the difference between a Physical Therapist and a Physical Therapy Assistant?
Physical Therapists (PTs) are highly-educated, licensed health care professionals. PT’s complete a three-year post-graduate program, earning a Doctorate of Physical Therapy degree. All therapists are required to pass a state licensure exam and are also required to take continuing education classes annually in order to maintain licensure. Physical Therapy Assistants (PTAs) are healthcare professionals who aide the physical therapist in treating patients. All PTAs are required to have an Associate’s Degree from an accredited PTA program and are licensed in the state of Virginia. PTAs work under the direction and supervision of a physical therapist
What can I expect from physical therapy?
You can expect to learn how to prevent or mange your condition so you can achieve long-term health benefits. Your Physical Therapist will follow the system below to ensure your time in physical therapy and at home is used effectively to reach your goals.
- Assess your symptoms.
- Diagnose your condition.
- Plan your treatment.
- Treat your condition.
- Continually evaluate the effectiveness of your treatment and adjust the treatment plan if necessary.
- Help you to manage your condition at home and to prevent recurrence of problems.
- Communicate with any other health professionals involved in your condition, such as your doctor, to ensure continuity of care is maintained while achieving your goals.
The success of your physical therapy usually requires your co-operation outside of our PT clinic. You will probably be required to participate in a home exercise program or some modifications to your postural or lifestyle habits. Your dedication to these exercises and changes will greatly enhance the outcome of your physical therapy program and will help you to achieve your goals as quickly as possible.
Will my insurance cover physical therapy?
In most cases, physical therapy is a covered service; however, benefits vary by insurance plan. It is important to know your benefits before beginning therapy. Please contact your insurance company for specifics regarding your PT benefits.
How many visits will Medicare pay for each year?
Medicare doesn’t limit the number of outpatient therapy visits but rather places a financial limitation on these services. Effective January 1, 2019, a financial limitation (therapy cap) was placed on outpatient rehabilitation services received by Medicare beneficiaries. Outpatient Physical Therapy and Outpatient Speech-Language Pathology has a combined annual limit for 2019 of $2040. An exception to the therapy cap may be made when the patient’s condition is justified by documentation indicating that the beneficiary requires continued skilled therapy to achieve their prior functional status or maximum expected functional status within a reasonable amount of time. Providers may utilize the automatic process for exception for any diagnosis for which they can justify services exceeding the cap for our Medicare patients, we track all Medicare financial limitations and will discuss all treatment options prior to the annual cap being met.
Do I need a referral / prescription for physical therapy?
Yes, per Virginia state law a signed referral / prescription from a referring doctor is required every 30 days for physical therapy. Patients are required to obtain this prescription and bring it with them to their initial appointment. In Virginia, we are also able to treat patients without a referral / prescription for 30 days under Direct Access laws. If therapy needs to continue beyond 30 days, a signed referral / prescription from a referring doctor is required. Patients may be required to see a doctor to obtain a referral / prescription before continuing therapy beyond the initial 30 day period.
Do I need authorization for physical therapy?
Some managed care plans require written authorization forms from your Primary Care Physician (PCP) for each visit to a specialist. If you have one of these plans, it is your responsibility to make sure a valid authorization is on file before each therapy visit. Often times these forms cannot be issued retroactively. Failure to obtain authorization from your PCP may drastically reduce your benefits / coverage with your insurance carrier.
It is important to know your plan requirements before beginning therapy. Please contact your insurance company for specifics regarding your PT benefits.
What happens when my insurance benefits run out?
Each insurance plan has different coverage limits. Once your benefit limits are exhausted, you may continue treatment as a self-pay patient. We also offer a wellness plan that is a monthly payment. Call for more information.
**Payment is due at the time services are rendered for all self-pay patients.**
We participate with most major insurances and will be happy to handle all insurance claims. If you do not see your insurance provider listed below, please contact one of our clinics to see if we accept your insurance.
- Aetna Medicare (Advantage Plan)
- Align / One call PT (W/C)
- Humana Medicare (HMO & PPO)
- MDIPA (UHC)
- Medicare Supplemental Plans
- Medrisk (W/C)
- Mutual of Omaha
- PMA – Prince William County Schools (W/C)
- Samba (Cigna)
- Sentara Optima Health
- Tricare (Humana Military)
- UHC CCC+
- UnitedHealthcare / UHC Medicare (Advantage plan)
- Veterans Administration
- Worker’s Compensation plans
*** We also have Self Pay options available for individuals without health insurance.***
We are out-of-network with the following plan(s):
All Medicaid MCO plans (ie, Aetna Better Health, Anthem Healthkeepers Plus, Magellan Complete Care, Kaiser Permanente, Optima Family Care, and VA Premier)