FAQ

The following FINANCIAL POLICY is included in your New Patient Packet

_______  Initial  *PLEASE NOTE THIS IS ONLY A VERIFICATION OF BENEFITS, NOT A GUARANTEE AND IS SUBJECT
TO CHANGE. ANY AMOUNTS NOT COVERED BY INSURANCE WILL BE YOUR RESPONSIBILITY.*

I understand I will be responsible for the amounts shown above. As a courtesy, we verify insurance benefits for patients. This in
no way guarantees that your insurance company will pay exactly as quoted, benefits cannot be guaranteed over the phone. This
facility is not responsible for obtaining or being aware of your policy requirement for referrals from your primary care physician,
pre-certifications, or limits with your specific policy. Your insurance policy is a contract between you and your insurance company; therefore the responsibility lies with you, the patient, to be aware of this information. We will assist you if necessary to help
you obtain this information. AthletePlus, is not obligated to withhold statements or to wait until settlement has been made
before receiving payment for services. I understand that payment will be collected at the beginning each visit. AthletePlus
does offer payment plans for your convenience; however we do reserve the right to refuse treatment if payment is not paid
as per this agreement.  

Yes, we pride ourselves on offering many different options:

Payment Options:  

• Check or Echeck,
• Credit Card (Am Ex, Master Card, Visa)
• Apple Pay
• PayPal
• Care Credit.
• Cash

Also Available:

• AutoPay
• Recurring Payment Plans,
• Direct Self Pay
• Membership Programs
• Care Credit Financing available.

If Self Pay or being treated as self pay because of high deductible, ask for our Self Pay Policy.

 AthletePlus will electronically (or manually if electronically is not available) send your billed charges to your insurance company.  We will submit claims on your behalf to your insurance company. For billing questions, therapy@athleteplus.net or call 751-8437.

Below is information included in your New Patient Packet

_______  Initial  *PLEASE NOTE THIS IS ONLY A VERIFICATION OF BENEFITS, NOT A GUARANTEE AND IS SUBJECT TO CHANGE. ANY AMOUNTS NOT COVERED BY INSURANCE WILL BE YOUR RESPONSIBILITY.*

I understand I will be responsible for the amounts shown above. As a courtesy, we verify insurance benefits for patients. This in
no way guarantees that your insurance company will pay exactly as quoted, benefits cannot be guaranteed over the phone.
This facility is not responsible for obtaining or being aware of your policy requirement for referrals from your primary care
physician, pre-certifications, or limits with your specific policy. Your insurance policy is a contract between you and your
insurance company; therefore the responsibility lies with you, the patient, to be aware of this information. We will assist you
if necessary to help you obtain this information. AthletePlus, is not obligated to withhold statements or to wait until settlement
has been made before receiving payment for services. I understand that payment will be collected at the beginning each visit. AthletePlus does offer payment plans for your convenience; however we do reserve the right to refuse treatment if payment
is not paid as per this agreement.  

Yes and it is called Direct Access.  Currently, all 50 states and the District of Columbia (DC) allow patients to be evaluated by a physical therapist without a physician’s prior referral.  Physical therapists are well-qualified, both through formal education and clinical training, to evaluate a patient’s condition, assess his or her physical therapy needs and, if appropriate, safely and effectively treat the patient. Physical therapists are also well-qualified to recognize when patients demonstrate conditions, signs and symptoms that should be evaluated by other health care professionals before therapy is instituted. Restrictions in access to care cause delays in the provision of physical therapists’ services to individuals who would benefit from treatment by a physical therapist. Delays in care result in higher costs, decreased functional outcomes, and frustration to patients seeking physical therapy treatment. Eliminating arbitrary barriers results in timely, more effective care. For example, a 2012 study in Spine states if you hurt your back, starting PT within the first 14 days can save you on average over $2700.

AthletePlus accepts and will file most insurances, but a copay or co-insurance may be required on your part. Some patients elect to be treated on a cash basis.  Payment Options:  Check,  Echeck, Credit Card (Am Ex, Master Card, Visa) Apple Pay, PayPal, Care Credit.AutoPay/Recurring Payment Plans, Direct Self Pay/Membership Programs and Care Credit Financing available

If Self Pay or being treated as self pay because of high deductible, ask for our Self Pay Policy.Speak with our business manager for details on insurance. We have flexible plans for those without insurance.  There may be more insurances that we accept so please call 751-8437 or email therapy@atheteplus.net. Here is a list of the insurances we currently accept:

• Aetna
• Aetna Workers Comp Access
• Align Network
• Ambetter
• American PPO
• Ancillary Care Services
• Arkansas Managed Care Organization
• Blue Cross & Blue Shield
• Care Improvement Plus
• Cigna
• CorVel Corporation
• Coventry/First Health/Medicare Advantra
• Employers Health Choice
• Evolutions Healthcare
• FedMed
• Fortified Provider Network
• Galaxy Health Network
• HealthLink of Arkansas
• Heartland Therapy Provider Network
• Integrated Health Plan
• Medicare
• Medicaid (Up to Age 21)
• Municipal Health Benefit
• National Comp Care
• NovaSys
• NPPN
• Physician Health Choice /Wellmed [Limited Areas]
• PPO Plus
• Prime Health Services
• Provider Select
• Private Health Care System
• QualChoice of Arkansas
• Rockport Healthcare Group
• Three Rivers Provider Network
• TriCare
• Tyson Preferred Network
• UMR
• United Health Care
• USA Managed Care Organization
• Windsor Health Plan

Talk with your employer/benefits manager. The employers who contract and pay for employee health care plans often have the most influence with insurers. Employers are interested in keeping their employees on the job and their premiums low, so providers who can help employees prevent injuries and avoid recurrence (as well as promote a healthy lifestyle) have particular appeal to them. Arrange a meeting with your human resources director or whoever is responsible for negotiating the terms of the company’s insurance plan.

Ask your human resources director or insurance company the following questions to determine if your current benefits package gives you access to appropriate physical therapy services:

1. Is your physical therapy benefit “bundled” with those of other providers of care? Physical therapy services should be listed separately in the benefit language so that access to necessary services is not compromised.

2. Does the benefit language permit access to physical therapists for each condition during the year? Benefit language should permit treatment of more than one condition in a calendar year (eg, ankle fracture in January and low back injury in July).

3. Does the benefit language permit access to physical therapists for each episode of care? A person may require more than one episode of care for the same condition. For example, someone with arthritis may receive physical therapy intervention for knee weakness in an attempt to avoid surgery. While this is often successful, some patients may still require surgery for the knee condition (eg, total knee replacement), which may require post-operative physical therapy treatment. The benefit language should support each “episode of care.”

4. Does the benefit language ensure coverage that facilitates restoration of function? Benefit language that restricts physical therapy care to a 60- or 90-day period imposes an arbitrary limit on recovery. In determining an appropriate physical therapy benefit that will allow an individual to return to his or her previous level of function, benefit language should reflect the normal amount of time that it takes to recover from an injury or from surgery.

5. Does the benefit language ensure coverage that promotes functional independence for those with chronic conditions? Someone who has a chronic condition may need to be seen periodically by a physical therapist. The physical therapist will determine if the individual’s home program, equipment, or adaptive devices should be modified. (For instance, children requiring orthotic devices will need modifications to those devices as they grow.) Benefit language should ensure that someone with a chronic condition may receive the kind of care that promotes personal safety and the greatest degree of function possible.

Millions of Americans are offered a choice of health plans through their employers, but the question is “What makes a good health care plan?” Here are some things to consider when choosing a health plan.

• Are you choosing a plan simply because it is the cheapest? This may not be the best way to go. Some inexpensive plans have a high deductible and no comprehensive coverage.
• Is the plan accredited by the National Committee on Quality Assurance? This is a good indicator of quality.
• Are your current doctors and specialists in the plan? If not, make sure you will be able to see a certain provider or specialist, such as a physical therapist, without too much added expense and difficulty.
• Is physical therapy coverage adequate? If you should have an injury or illness requiring rehabilitation, you will need a plan that offers an unlimited number of visits to a physical therapist or that allows for the number of visits to be extended if needed.
• Are there lifetime limits on benefits? If so, you could face a serious financial crisis if you or a covered member of your family suffers a major illness or injury.
• Does the plan have an out-of-pocket maximum? In this case, once you have paid a certain amount (usually several thousand dollars) the plan would cover the rest.
• How does the plan handle grievances and appeals? The procedure should be simple, timely, and accessible.
• Does the plan permit use of out-of-network doctors, specialists, or hospitals? Called “point-of-service” option, this would allow you to see a provider, such as a physical therapist, who is not in your plan. There may be an additional cost, but it may be worth it.
• What is the plan’s dis-enrollment rate? A high rate of members leaving the plan annually may indicate customer dissatisfaction.

Navigating your way through health insurance benefits can be a challenge. It is very important to understand the terminology especially when deciding which benefits will work for you and finding a plan that will best meet your needs.

This brief glossary will provide insight for some of the more common terms when dealing with health insurance.
co-insurance: in indemnity, the monetary amount to be paid by the patient, usually expressed as a percentage of charges.
co-payment: in managed care, the monetary amount to be paid by the patient, usually expressed in terms of dollars. consumer driven health care (CDHC): refers to health plans in which employees have personal health accounts such as a health savings account, medical savings accounts or flexible spending arrangement from which they pay medical expenses directly.
deductible: the portion of medical costs to be paid by the patient before insurance benefits begin, usually expressed in dollars.
denial: refusal by insurer to reimburse services that have been rendered; can be for various reasons.
eligibility: the process of determining whether a patient qualifies for benefits, based on factors such as enrollment date, pre-existing conditions, valid referrals, etc.
exclusions: services that are not covered by a plan.
flexible spending arrangements (FSAs): an account that allows employees to use pre-tax dollars to pay for qualified medical expenses during the year. FSAs are usually funded through voluntary salary reduction agreements with an employer.
gatekeeper: in managed care, it refers to the provider designated as one who directs an individual patient’s care. In practical terms, it is the one who refers patients to specialists and/or sub-specialists for care.
health maintenance organization (HMO): a form of managed care in which you receive your care from participating providers.
health savings account (HSA): a savings product that serves as an alternative to traditional health insurance. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.
managed care: a method of providing health care, in which the insurer and/or employer (policyholder) maintain some level of control over costs and utilization by various means. Typically refers to HMOs and PPOs.
member: a term used to describe a person who is enrolled in an insurance plan; the term is used most frequently in managed care.
open enrollment: a set time of year when you can enroll in health insurance or change from one plan to another without benefit of a qualifying evening.
out-of-pocket: money the patient’s pays toward the cost of health care services.
payer: the party who actually makes payment for services under the insurance coverage policy. In the majority of cases, the payer is the same as the insurer. But, as in the case of very large self-insured employers, the payer is a separate entity under contract to handle the administration of the insurance policy.
policyholder: purchaser of an insurance policy; in group health insurance, this is usually the employer who purchases policy coverage for its employees.
preferred provider organization (PPO): a form of managed care in which the member has more flexibility in choosing physicians and other providers. The member can see both participating and non-participating providers. There is a greater out-of-pocket expense if member sees non-participating providers.
premium: the cost of an insurance plan shared by employer and employee.
provider: one who delivers health care services within the scope of a professional license.
reimbursement: refers to the payment by the patient (first-party) or insurer (third-party), to the health care provider, for services rendered.