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Frequently Asked Questions

Your questions about

Therapeutic Wellness and Concierge Services

are answered here!

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FREQUENTLY ASKED QUESTIONS

  • Does My Insurance Pay for Therapeutic Wellness?

    • No, standardly insurance does not cover services that they deem not medically necessary. Such things per Medicare National Coverage Determination Chapter 1, Part 3, Section 170: the educational activities are not closely related to the care and treatment of the patient, such as programs directed toward instructing patients or the public generally in preventive health care activities, reimbursement cannot be made since the Act limits Medicare payment to covered care which is reasonable and necessary for the treatment of an illness or injury. For example, programs designed to prevent illness by instructing the general public in the importance of good nutritional habits, exercise regimens, and good hygiene are not reimbursable under Medicare. 

  • Isn’t Medicare Paying for My Therapy Already?

    • Medicare pays only for the portion of therapy that is treating a specific diagnosis that meets medical necessity. We treat the whole body system and provide you with exercises and interventions to help you get the best results possible. According to the Social Security Act Section 1862(a)(1)(A) “Medicare” excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. And it says in Medicare Claims Processing Manual Chapter 5 Note that because a service is considered an outpatient rehabilitation service does not automatically imply payment for that service. 

  • What is Medical Necessity?

    • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

  • Is This a Fee for Overhead of Therapy?

    • No, if you are receiving care that is reimbursable by Medicare only the appropriate units for those services will be billed and they cover the overhead cost in their fee schedule. The non-facility rate (that is paid when the provider performs the services in its own facility) accommodates overhead and indirect expenses the provider incurs by operating its own facility. Medicare Claims Processing Manual Chapter 5, Section 10.

  • What if I Want Care for My Problem After Medical Necessity?

    • No problem, we will provide you with an Advanced Beneficiary Notice of Noncoverage (ABN). This will allow you to select if you want treatment to continue or not, and that you understand if we continue you are responsible for the treatment. 

  • Does Medicare Pay for My Rest or Wait to Do the Next Intervention?

    • No rest time and general discussion are not a covered service per Medicare Claims Processing Manual Chapter 5, Section 20.3. However, this is part of the time we get to know you and find out what else is going on in your life and how we can help.

  • What Happens if I Have an Injury for Something Else While Being Seen?

    • We are happy to screen and evaluate the new issue. If it meets medical necessity, we will add it to your current plan of care, if it does not it will fall under your therapeutic wellness plan and we can focus on it as needed.

  • Why Do I Have to Pay an Additional Fee for Therapeutic Wellness?

    • Here at Titan Physical Therapy we are trained to look at you as a whole person. We know if your body system is not healthy, it is going to limit your overall recovery and prevent you from reaching your goals. Unfortunately, this is outside of the normal practice for most clinics. (Something we hope to see change). Your Doctor of Physical Therapy is only going to provide you with the highest level of care  to address you as a whole and this is what therapeutic wellness covers. 

  • Do You Offer Payment Plans?

    • We do have a few payment options available such as monthly, episode of care and annual plans. To qualify for these speak to Avery or Kara Schroyer, non-contract options will need to be approved before the start date.

  • What If I Only Want To Be Treated for The Issue I Have?

    • We can understand you wanting to just focus on one issue. However, your body is dependent on all of its systems. We will be happy to answer your specific concerns during your evaluation. If you do not wish to proceed with care with us after that, you do not have to pay for therapeutic wellness. 

  • Do You Ever Just See Someone for a Specific Treatment? I.E. Dry Needling, Ultrasound, Compression?

    • Yes and these services are covered under your therapeutic wellness plan.

  • How Often Do You Typically See Clients for Therapeutic Wellness?

    • This depends on your goals and current health status. Most of our clients, however, fall into two categories of either once a week for 30 min. sessions, or once every-other-week for 1 hour sessions. 

  • What if I Need/Want More Than 2 Hours of Therapeutic Care a Month?

    • You can always purchase more time if you would like. Our base plan is for 2 hours of in clinic care, along with all of the support for therapeutic wellness and your success. However, there are other plans available to meet your specific needs. Please contact Avery or Kara to discuss additional purchase options to add to your plan.​

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