Insurance

Our main concern is the management of medical problems or other health related conditions that cause pain, limit your mobility, and stop you from performing your daily activities. We aim our intervention at restoring and maximizing functional and recreational skills that may have been threatened by the process of aging, injury or disease. Here is an insurance list that we accept here at Fresh Pond Physical Therapy:

• 1199 (OUT OF NETWORK)
• AARP
• Aetna
• AFFINITY BY MOLINA HEALTHCARE
• Amerigroup
• Cigna
• CENTERS PLAN FOR HEALTHY LIVING
• Healthplus
• Elderplan
• ELDERSERVE
• Empire BC/BS
• Empire Medicare
• Empire Mediblue
• Fidelis Care
• GHI (Out Of Network)
• Healthfirst
• HUMANA
• INTEGRA
• MAGNACARE (OUT OF NETWORK)
• Medicaid
• Medicare
• No-Fault
• Orthonet Aetna
• Orthonet Cigna
• Orthonet Empire
• OSCAR
• United Health Care
• Wellcare
• Workers' Compensation

We also offer excellent self-pay option packages.

Understanding Your Health Insurance

People often are confused about the coverage they receive from their insurance carrier. You must understand that an insurance policy is a legal contract between the insurance company and you. The company determines what is covered; the length of time it will be covered and most important: any costs you may be responsible for.

Deductible

The deductible refers to the amount of money that the insured would need to pay before any benefits from the health insurance policy can be used. This is usually a yearly amount so when the policy starts again, usually after a year, the deductible would be in effect again. Some services, like doctor visits, may be available without meeting the deductible first. Usually there are separate individual deductible amounts and total family deductible amounts.

Co-insurance

This is usually a percentage amount that is the insured's responsibility. A common co-insurance split is 80/20. This means that the insurance company will pay 80% of the costs and the insured is required to pay the other 20%.

Co-payments

The co-payment is a fixed amount that the insured is required to pay at the time of service.

Out-of-Pocket Cost

This is the cost one would pay out of his or her own pocket. An out of pocket expense can refer to how much the co-payment, coinsurance, or deductible is. Also, the term may mean how much the insured would have to pay if their insurance carrier denies treatment or they have reached the maximum number of visits allowed. You must understand that just because you have insurance it does not mean you have zero responsibility when it comes to paying for the treatment you were provided. Before you seek treatment we advise that you contact your insurance carrier and find out exactly what is covered, for how long, and what they require you to pay to the provider.

Service limits per calendar year

Your plan may limit certain services in a calendar year. For example, you may be covered only twenty physical therapy treatments per year and if your insurance does not authorize additional visits you would be responsible for paying for your treatment. If you disagree with a decision or action by your health plan such as a denial of coverage, refusal to authorize treatment, or any other adverse action, you may have the right to a review of that decision. That means that you can make a formal request to have the insurance carrier reconsider a decision related to your coverage. New York State also provides an "external review" procedure for health care claim denials such as deemed not medically necessary by an insurance carrier. If you would like more information please contact us.

Financial hardship

If you do not have coverage, or you have exhausted your benefits and meet certain income and other financial criteria you may qualify for financial hardship. If you do you may be entitled to reduced cost payments for treatment services. Should you wish to apply for this option please call us or stop in at one of our offices and request a Financial Hardship form.