+ Do you take insurance at Diverge?
Diverge Performance Therapy is not a participating provider with any insurance plans. Why not? Simply put, we would not be able to provide the kind of high level care, individualized treatment that we do currently when working within an insurance-based model.
In clinics that bill insurance, therapists must see multiple patients at one time to off set insurance reimbursement rates. On average, insurance companies tend to reimburse about 40% of what a therapist bills out. Many outpatient clinics are forced to utilize Physical Therapy Assistants or technicians to oversee a patients care. Often a patient may only spend 10-15 minutes with the Physical Therapist and be sent off to complete their exercises independently. In addition, insurance companies tend to dictate the number of sessions a patient is allowed regardless of the nature and depth of their injury or condition, causing them to stop therapy short and putting them at increased risk of re-injury.
At Diverge, you spend the full session with a Doctor of Physical Therapy, and will likely require fewer visits overall to meet your goals. Our costs vary, but we offer package options that can help reduce the per-visit cost. Depending on your plan, your insurance company may reimburse you for part of the cost.
+ Why do you not accept insurance? And did you say you can actually save me money?
The short answer:
In many ways, insurance companies dictate or strongly influence the treatment that patients receive at “in-network” clinics, and we refuse to accept this at Diverge.
The longer answer:
We are an out-of-network practice because the business model necessary for an in-network practice to survive rarely ever allows for the high-level care we insist on giving our patients.
What the heck does that mean? …
Due to progressively worsening reimbursement rates and pressure from insurance companies, the therapists at in-network clinics have to see at least 2 patients per hour (usually many more) and they often use technicians and assistants to provide much of the actual patient care. The care often includes modalities like heat packs and ultrasound, and the majority of a patient’s time at the clinic is spent doing exercises they could do on their own time. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week.
We do not believe that modalities are nearly as effective as our hands-on treatment, and we also do not agree with having patients pay to perform exercises in the clinic that they can easily perform at home or at a gym.
All of our patients receive one-on-one care and hands-on treatment from a Doctor of Physical Therapy in every session. Most sessions are a full hour. With this long-session, one-on-one treatment approach, the plan of care for the vast majority of our patients only involves one appointment per week at most.
When you consider the time savings of fewer trips to the clinic and the value of resolving your pain so much faster than average, the out-of-pocket expense at Diverge is a huge bargain.
On top of that, the out-of-pocket expense for our treatment sessions is sometimes less than a patient would pay at a clinic that accepts and bills their insurance.
How is that possible?!
As deductibles and PT copays have skyrocketed in recent years, many of our patients who have high PT copays or have not met their deductible pay less out of pocket for our treatments than they would if they went to a clinic that “takes their insurance.”
So before deciding on where to get PT based solely on which clinics “take your insurance,” make sure you know how much you’ll be paying at your in-network options versus an out-of-network clinic like ours…
These days, some insurance plans provide zero coverage for PT visits or require copays of over $50/visit. And if you have a deductible to meet, you’ll likely end up paying the full bill for your PT sessions until you meet the deductible (and these bills are often $200+ per session). However, you usually won’t start receiving those $200+ bills until after you’ve been getting care for 6-8 weeks and have racked up an enormous total balance (again, often being asked to attend PT 2-3 times per week).
And guess what else…just because you’re paying $200+ per session at a clinic that is in-network with your insurance, does not mean that your insurance is applying that full amount towards your deductible! They often only apply the amount that they have agreed is reasonable for your PT sessions which is, of course, far less than the amount the PT clinic actually charges.
Most people are quite unaware of the games their insurance companies play in order to pay out as little as possible and maximize their profits. So as you weigh your PT options, it’s very important to:
- Inquire with your insurance company about what percentage of the total PT bill you will be required to pay at an in-network clinic (especially if you still have a deductible to meet). If you will be paying 100% of the bill till you’ve met your deductible, ask the prospective PT clinic the amount of the average bill sent to an insurance company (the PT clinic’s amount on the bill … NOT what the insurance company has agreed they will pay the clinic). In most cases, you will ultimately be paying the full bill until your deductible is met.
- If you have met your deductible, ask how much your copays will be? Ask how many times per week the average patient is asked to come in for treatment.
- Consider the quality of care you’ll be receiving at your various options, and how much value you place on receiving higher-quality, one-on-one care from a Doctor of Physical Therapy rather than a PT Assistant (PTA) or an unskilled “Tech.”
- Consider how often you’ll be missing work and/or time with family to attend your PT sessions. Again, you can ask any prospective clinic how many times per week their average patient is asked to come in for treatment.
Ask the above questions, do the math, and you may be quite surprised at what you find!
*One other thing to consider is whether or not you have just one deductible or if you have both an in-network deductible and an out-of-network deductible. If you have two deductibles, then claims from an out-of-network clinic like ours will not apply to your in-network deductible.
With all the above information, you can now get a real sense of what your true costs will be, what level of care you’ll be getting, and then make the best decision on where to receive your physical therapy treatment.
+ Can I pay with my HSA or FSA?
You certainly can! We are qualified medical providers, so we happily accept HSA or FSA!
+ How do I get reimbursed?
We will provide you a "superbill receipt" after each visit to submit to your insurance company, but you will need to send the claim into your insurance company yourself. The insurance company will then reimburse you directly. They must not pay us as you have already done that, and we don’t need to get paid twice for the same service!
The amount of reimbursement is completely dependent on your insurance plan. If you call your insurance company to inquire, you should ask about reimbursement for “out-of-network, out-patient Physical Therapy” expenses.
Alternatively, we are proud to partner with Better Co, a company who can help you with your reimbursement claim. Please see below for more information.
+ I have Medicare. Can I still receive treatment at Diverge?
The US government has some interesting laws that control where Medicare beneficiaries can spend their healthcare dollar and persuade healthcare providers to enroll in their system. Because we are not Participating Medicare Providers, we can only accept Medicare beneficiaries as patients when the patient does not want Medicare billed for any PT services. This request to not involve Medicare in payment must be made up front by the patient and be made of the patient’s own free will.
In other words, if you’re a Medicare beneficiary and are adamant about seeing us for your care even though we are not participating Medicare providers, we can help … However, the only way we can provide you with PT services is when you truly don’t want Medicare involved and you ask up front that Medicare not be billed or involved in your physical therapy care.
If you do want to use your Medicare benefits for physical therapy, we cannot provide you with treatment at our clinic but we can help you find a good Medicare provider in your area.
+ Do I need a Doctor's prescription to attend Physical Therapy?
No! PT’s in the state of Ohio have direct access, meaning no physician prescription is required to access physical therapy services. This saves you time and money, getting you the treatment you need exactly when you need it, without wasting time/money for a visit to your physician just to get a referral.
+ What should I expect at my first visit?
Wear comfortable clothes and shoes that will allow your injured area to be examined.
Be prepared to move. A thorough examination of your movement, strength, flexibility, posture, and painful areas will be performed. We will be looking at multiple body parts to assess your full body’s function.
The first visit will involve more discussion and questions than subsequent visits as we learn about you and discuss your goals.
There will be time for treatment and developing an initial home treatment program.
+ How long does a typical session or series of sessions last?
Each session is for a full 50-60 minutes. Because each person and each injury is different, it can be hard to say how long it will take to be 100% again. You are receiving one-on-one hands-on treatment from a highly skilled therapist, so you should get better faster than traditional therapy clinics. Please understand that an acute injury will probably resolve more quickly than a chronic problem. Also, a complex condition might take time to determine the origin of the problem versus a more straight forward injury. Nonetheless, our goal is to get you back at it as quickly as possible.
We also hope you will add us to your team of medical providers. If pain returns, we ask that you call us ASAP so we can treat it quickly before it returns to its nagging state. Our role is not to discharge you and never see you again, rather we see this as a continuation of care that may need a “tune up” from time to time.
We have partnered with Reimbursify – an app that helps patients who pay out-of-pocket to get reimbursed by their health insurance.
After each visit, simply submit the superbill you receive via the Reimbursify app. They work with your insurance to get you reimbursed.
Find out more at Reimburisify above!