Blue Cross Blue Shield
PHCS - Network
Multi Plan - Network
Three Rivers Providers Network
Humana (starting August 1st)
Medicare

Under construction -
For now, please email or call for more information

We Are Working For You!

As many people may be experiencing, insurance coverage restrictions are affecting all aspects of health care.

Our intentions are to provide the most unencumbered service with the smoothest insurance and claims handling as possible.

However, as Medicare policies are becoming more stringent, and with other insurance companies following along, we are complying to make appropriate improvements with the modified requirements.

All insurance policies are implementing more defined "compliance regulations" to providers such as ourselves, and we are making every effort to abide by these requirements. Not only are these efforts being made at our office to improve insurance services and prevent disruption of provider contracts but to keep pace with more appropriate and ethical insurance reimbursement.

Most people are unaware of the potential jeopardy that all medical facilities face by not cooperating and complying with these policy changes. While it may seem a major inconvenience and deterrent to attaining our much needed services, we assure you that with a little patience and adaption to some changing procedures, we can continue to provide everyone with the same level of care and continued coverage of services that you require.

As with many of the economic issues our country is facing, we are all responsible for taking part in improving some very fundamental concerns of "over-utilization" of health insurance. Regardless of the cause, let's be confident that by taking appropriate measures, we can regain the confidence and cooperation of government and insurance leaders to provide the coverage we all deserve.

Following are some of the policies and new procedures you can expect to find at our office. Please contact us with any questions but understand that we are making every effort to make these procedures as simple and convenient as possible.

• ‘Functional assessments’ are used to evaluate the need for treatment and progress of care. That means that we will be asking about and documenting your ability to perform tasks and ‘function’. If you have a decreased or inability to climb stairs, get in and out of your car, raise your arm to dress yourself, lift or care for your children, or even turn to swing a golf club or bend for bowling, then these are valid measures to evaluate the need and progress of care. (Even though the reason for your condition is most likely pain, functional assessments offer a better measure of evaluation and need for care.)
• You will be asked to fill out simple questionnaires and pain scale forms at intermittent visits to contribute to the assessment and progress of your care.
• While we can treat patients for any relevant condition or concern, insurance plans including Medicare will only pay for treatments that are “Medically Necessary” or “Clinically Appropriate” to restore functional deficit or reach a treatment goal such as getting you back on your feet and able to climb your stairs.
• Treatments that do not result in the progress of a functional problem or that do not have an outcome goal are considered as maintenance, or if the patient has reached the goal of maximum improvement, then in either case further treatments are not covered reimbursement. While we strongly encourage it and patients often greatly benefit, if a patient requests maintenance treatments or as a “check-up”, those treatments are not covered by insurance or Medicare.
• Along with other assessment tools, periodic re-examinations are required to be performed to assess and evaluate progress. Although this policy has not changed in our office, it is a frequently asked question. Even for non-insurance, cash-based patients, our standard of care requires that we perform these necessary evaluations.

If you have questions about your coverage, don't hesitate to contact your insurance company and ask for coverage details. Our office staff is highly experienced at helping to contact them and make sense of it with you. Call our office or submit an email to request more information.