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, Community Health Options, 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.
PAYMENT FOR PHYSICAL THERAPY
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 CROSSFIT BEACON, GREAT BLUE ACUPUNCTURE, SALUD PILATES & THE MOMMA MOVEMENT
These services are provided by CrossFit Beacon, Great Blue Acupuncture, Salud Pilates, and The Momma Movement. Payment for these classes will be required at sign-up and are paid for through our secure scheduling platform.
CAN I USE MY HSA FUNDS TO PAY FOR SERVICES AT H2O?
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.