OUR REIMBURSEMENT PHILOSOPHY AT H2O:
We at H2O believe that it is our professional and ethical responsibility to accept Medicare and most primary insurance carriers so that we are able to provide a majority of our community with quality and compassionate outpatient orthopedic physical therapy services. That being said, H2O is a contracted provider with Medicare, MCHO, Harvard Pilgrim, Anthem, Aetna and more, therefore we are contractually obligated to maintain a level of care and fiscal responsibility to uphold optimal utilization of benefits and outcomes. Under these contractual obligations between H2O and insurance carriers, we strive to give you the best services possible to facilitate your recovery while minimizing the number of insurance visits necessary, therefore it is the work of both you and your provider to maintain ethical and fiscal responsibility during your treatment duration at H2O.
CAN I USE MY HEALTH INSURANCE FOR SERVICES AT H2O?
H2O Fitness Collaborative will bill your health insurance for outpatient physical therapy appointments that are considered medically necessary. We accept most major health insurances including Medicare. Your specific health plan coverage determines the amount you pay versus the amount your insurance pays for services. Below are some examples:
The expense could be allocated toward your deductible. A deductible is the portion of medical costs you pay for BEFORE your insurance pays. If you have a $200 deductible, then you will pay $200 before your insurance begins to pay.
Or, you may have a co-insurance. A co-insurance is a percentage that you pay for services, usually after your deductible is met. For example, Betty has a $4000 deductible. When she initiates treatment for physical therapy she has $350 remaining on her deductible. After 3 visits, her deductible is met (she has paid out of pocket), however, she now has a co-insurance. Her insurance might pay for 80% of the allowable charges, and Betty will only pay the remaining 20%.
You may have a copay. A copay is a fixed amount that you pay for each visit.
Occasionally a portion of your visit may not be considered a covered service. This means that your insurance does not believe the service is medically necessary or medically warranted. This may be the case with certain procedures performed during your physical therapy appointment. Your therapist will alert you to non-covered services and the out-of-pocket cost for the service. You can then make an informed decision on whether you would like to receive the service.
Remember, most plans have calendar year deductibles, so keep in mind when the plan renews your patient responsibility will increase.
PAYMENT FOR PERSONAL TRAINING, NUTRITION CONSULTS, AND CUSTOMIZED FITNESS PLANS:
These are cash-based services. You are required to pay for the service prior to your visit. Please review the information below to see if you qualify to use your HSA funds to pay for these services.
PAYMENT FOR PILATES, MOMMA MOVEMENT, AND FUNCTIONAL STRENGTH CLASSES:
These services are provided by Salud Studio and Beacon Community Fitness. Payment for these classes will be required at sign-up and are paid for through our secure scheduling platform.
INSURANCE COVERED SERVICE
Orthopedic Physical Therapy services are covered by Medicare and most primary insurances when the appropriate ICD-10 diagnosis is determined and deemed medically necessary requiring skilled physical therapy techniques to address musculoskeletal impairments, often impacted by co-morbidities, slowing the natural healing process and significantly limiting daily functional capacity.
An example of someone appropriate for physical therapy treatment and coverage: Bob recently sprained his ankle and the moderate swelling, pain and restricted range of motion is limiting his ability to walk up and downstairs in his home. Bob seeks skilled PT treatment so to be able to negotiate stairs and sleep in his bed sometime in the near future. Bob is appropriate for our Orthopedic Physical Therapy Services.
An example of someone not appropriate for insurance-covered physical therapy treatment: Tiffany (because the 80's were amazing) has an old ankle sprain from 2 years ago resulting in mild calf weakness, tightness, and minimal dorsiflexion loss. Tiffany is able to perform all daily functional tasks and enjoys mountain biking and hiking on the weekends. Tiffany wants to hike the Appalachian Trail in 3 months but is concerned that her ankle will limit her goal. Tiffany is not appropriate for insurance-covered physical therapy benefits as she is at full functional capacity based on the perspective of most insurance carriers. Tiffany is searching for higher level recreational capacity and therefore is appropriate for our non-insurance-based customized Strategic Fitness Services to provide her with high-level full-body strengthening and fitness strategies necessary to get her on her way to a successful hike.
* Most insurance carriers have a limitation in the number of visits per episode of care and/or an annual cap limiting your available outpatient physical therapy services.
* Although we are always willing to help explain your outpatient PT benefits when necessary, it is ultimately your responsibility to understand, update and/or obtain the details of your specific coverage.
From Injury To Performance, Our Staff and Facility are Prepared to Address all of Your Rehabilitation Needs!
What Makes our Physical Therapy Center Unique?
Unlike most out physical therapy facilities that can address either the first stage of sub-acute care or the last 20% of your performance, our facility was designed from day one with your full duration rehabilitation needs in mind from start to finish! Whether you’re recovering from rotator cuff surgery, ACL reconstruction, a back injury, or ankle sprain, we can provide you with a broad spectrum of services from acute injury straight through to recreational or game day performance.
Our facility and staff are set up with your success in mind with the help of the area’s most innovative equipment under one roof including:
Keiser Functional Trainers & Leg press
Boditrak Performance Computer Analysis
E550 Swim Spa with Underwater Treadmill with the Edge 3.0 Hydro Camera Recording Capacity
Indoor Turf & Rogue Functional Strengthening Equipment
Outdoor Agility Training Space
Outdoor Physical Therapy Treatment Space
Full Weight Lifting, Cardio and Strength Conditioning Rigs & Classes
Pilates Reformers & Classes
We have the experienced physical therapists and fitness professionals necessary to address your needs from injury to performance without any gaps!
USING YOUR HSA FUNDS TO PAY FOR H2O SERVICES
In today’s health insurance landscape, more and more consumers have health savings accounts (HSA). HSA’s are accounts that allow you to deposit pretax money that can be used to pay for qualifying medical expenses for you or other family members. Determining what you can pay for with money from your HSA can be a little tricky. The IRS has 2 documents that help clarify questions around the use of these pre-tax dollars.
This publication from the IRS outlines what is considered a qualifying Medical expense. It is summarized below:
What Are Medical Expenses?
Medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and for the purpose of affecting any part or function of the body. These expenses include payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners. They include the costs of equipment, supplies, and diagnostic devices needed for these purposes.
Medical care expenses must be primarily to alleviate or prevent a physical or mental disability or illness. They don't include expenses that are merely beneficial to general health, such as vitamins or a vacation.
IRS Publication 969 outlines the rules around Health Savings Accounts and Flexible Spending Accounts. We encourage you to speak with your tax advisor or accountant to determine whether the cash-based services you receive at H2O can be paid for with money from your HSA account.