New Year = New Insurance Benefits and Learning How to Find Out What Yours Are

Happy New Year 2017!

In the medical world, most insurance plans reset in January (such as Medicare and most commercial plans). This means a busy time for our front office staff to verify benefits for all our insurance-based clients. (They won’t let us verify the 2017 plans while it’s still 2016—we have tried!). This is a time-consuming process and the results are, unfortunately, not always the same as what we think the insurance plan promises. Typically, it isn’t until after the claim processes in the insurance’s system that we find out the real information on what their reimbursement policy will be.

All of us are starting to pay more for our insurance and getting less from them in return. In the medical world, a new term has been created called healthcare consumerism. (See our blog post Your Time. Your Money. Your Choice: How to pick the right physical therapist for you.)
Healthcare consumerism in a nutshell means you, as a patient, have the right to shop around, find the best medical providers to fit your needs (whether it be insurance companies, physicians, or other allied health providers). It also means if things are not working out, you have the right to find another provider/clinic to meet your needs.

At Monarch Physical Therapy, we are striving to provide you an exceptional level of care, tailored specifically to you, to meet your needs. One example is seeing people one-on-one for an hour. This is not the norm for most physical therapy clinics, but that is all you will find at Monarch. If you are pleased with your service here, feel free to leave us a review on google or a testimonial on our website. If you have any concerns, please schedule a time to talk to Brenda about your issues, as she would love to learn how we can make your experience better. In striving to be premier physical therapy providers, we also offer to verify your insurance benefits as a courtesy of doing business with us. We want to make sure you are your best advocate as well, and below you may find highlights on how to verify your own benefits—it’s a great way to learn the process and continue to be a proactive healthcare consumer.

All the best in the new year,


Monarch Physical Therapy – 830.431.0773

As a disclaimer, we are now preferred providers for all Blue Cross Blue Shield policies effective February 2017.

How to Determine Your Insurance Benefits for Physical Therapy

1. Call the toll free # for customer service on your insurance card. Select the option that will allow you to speak with a customer service provider, not an automated system.

2. Ask the customer service provider to quote your physical therapy benefits in general. These are frequently termed ‘rehabilitation benefits’ and can include occupational therapy, speech therapy, and sometimes massage therapy.

3. Make sure the customer service provider understands you are seeing a preferred provider/in-network provider.

What YOU need to know:

  • Do you have a deductible? Yes/No
  • If yes, how much is it? How much has already been met?
  • What percentage of reimbursement do you have? (60%, 80%, 90%, are all common)
  • Does the rate of reimbursement change because you’re seeing a preferred provider (BCBS patients only)? Yes/No
  • Does your policy require a written prescription from your primary care physician? Yes/No
  • If yes, will a written prescription from any MD/physician, or a specialist your PCP (primary care physician) referred you to be accepted? Yes/No
  • Does your policy require pre-authorization or a referral on file for outpatient physical therapy services? Yes/No • If yes, do they have one on file? Yes/No
  • Is there a $ or visit limit per year? Yes/No If Yes, What is it?

4. What this information means:

  • A deductible must be satisfied before the insurance company will pay for therapy treatment. Submit all bills to help reach the deductible amount.
  • If you have an office visit co-pay, the insurance company will subtract that amount from the percentage they will pay. This will affect the amount of reimbursement you will receive.
  • The reimbursement percentage will be based on your insurance company’s established “reasonable and customary/fair price” for the service codes rendered. This price will not necessarily match the charges billed; some may be less, some may be more.
  • If your policy requires a prescription or referral from your PCP you must obtain one to send in with the claim. This is usually not difficult to obtain if your PCP sent you to a specialist for help with your condition.

*Monarch PT will file your claim, but this gives you the information regarding your policy.


Brenda Bryson, PT, MPT, LMT

Leave a Reply

Your email address will not be published. Required fields are marked *

New Year = New Insurance Benefits and Learning How to Find Out What Yours Are


More Posts

Send Us A Message

Share This