Seven Myths About Insurance Reimbursement for Post-Rehab Services

Are you a PostRehabologist who has clients with insurance coverage? Are you not sure how to contact the insurance company? You have had an insurance claim denied because you were not sure what to do? Maybe you’re just not sure what insurance companies will reimburse. There are several myths about insurance reimbursement for Post-Rehab Services, here are the top 7 myths we often hear:

Myth #1: Insurance carriers won’t pay for post-rehab services. Actually, we find that insurance carriers are open to the idea of paying for post-rehab services, if they feel the services will benefit the client, improve the client’s overall level of function and the services are not used in lieu of the services provided by a licensed physical therapist, chiropractor or physician. Medicare and Medicaid will not pay for post rehab services.

Myth #2: I need a provider number to bill an insurance company and obtain insurance reimbursement. This isn’t necessarily true. The provider number is nothing more than a number used to identify the practitioner as a member of the network. The insurance carrier doesn’t say that non-providers can’t receive reimbursement; it just makes it a bit harder. The key is to obtain pre-authorization for post-rehab services. If you do have multiple fitness facilities, I would recommend you approach the insurance company to become a provider. There is an application process but fitness is becoming an integral part of the medical management of many conditions.

Myth #3: I can use a medical Treatment center insurance Georgia professional’s license to obtain insurance reimbursement for post-rehab services. This is absolutely not true, and may constitute insurance fraud. The idea of billing for post-rehab services under a license of a physical therapist, chiropractor, physician and/or nurse is 100% illegal. If the medical professional does not actually provide the services, then it is illegal for him or her to bill that under their license number. If you contact the insurance company, explain your programs and the benefits of your programs, you may find the insurance carrier receptive to paying you directly for post rehab services. 

Again, stay away using a medical professional’s license number; Treatment center insurance Georgia

Myth #4: I should bill just as much as the physical therapist and/or chiropractor charge. Please understand, insurance carriers keep track of every provider there is out there. From this standpoint, they’ve developed a profile on each medical provider in which they start to use these profiles to determine if someone is billing for outrageous treatments or billing for services that really shouldn’t be covered, or they’re excessively billing for services. Please understand, as a post-rehab professional, when you start to charge the exact same amount that a chiropractor or physical therapist does, remember your services may not be as specialized. And, also, that’s not saying that a physical therapist or chiropractor is better, but when you’re billing at their same level, remember their overhead cost may be a little different, probably greater, and you also have to remember there’s a higher level of professionalism. I don’t mean that in a negative sense, but please understand, when you start trying to bill the same thing that the physician, chiropractor or physical therapist do, eventually the insurance carrier is going to adjust those charges such that you’re going to end up getting what they want you to receive rather than what you are asking for. So play fair with the insurance companies. I guarantee you in the long run you’ll be better off.

Myth #5: I can make a lot of money working with seniors and getting insurance reimbursement for senior fitness services. Medicare and Medicaid will not pay for post-rehab services. In the past, a couple of groups in Arizona and Florida have received reimbursement from Medicare for group-based fitness services, but after one or two payments, Medicare makes any further claims. Workman’s compensation carriers, motor vehicle accident carriers, and some third-party carriers are more receptive. Medicare and Medicaid absolutely will not pay for post rehab services.

Myth #6: All I have to do is just simply send the insurance carrier my bill and I will get a check. You must contact the insurance carrier in advance to obtain pre-authorization for post rehab services. This means you will have to conduct an assessment, determine the exercise program and then contact the insurance carrier. The insurance wants to know how long, how often and how much, with regard to the post-rehab services. The idea of just simply submitting a bill and thinking the insurance carrier is going to pay you because the client has insurance coverage is not smart. Remember physicians, physical therapists, chiropractors, hospitals, surgical centers, all do the exact same thing, obtaining pre-authorization for services and/or products. They don’t just simply submit a bill.