Insurance Info

Hopefully, we can simplify this for you…

The best way to take care of your health is to take an active role in your own health care. To do this, you need to know about your options and your rights as a patient. Patients across the country are becoming better educated and demanding more and better options from their health insurance companies. The right to physical therapist services is an important option, and it is your right as a patient.

Do I need a referral from my doctor to start physical therapy?

New Jersey is a direct access state for most insurances, therefore, you do not need a referral to begin physical therapy. All Medicare patients require a doctor’s referral before seeing a Physical Therapist.

Navigating the world of healthcare insurance can be complicated and confusing. Upon scheduling your first appointment, our friendly front office staff will assist you in verifying physical therapy benefits through your insurance plan. We will work with you to make sure that any information regarding your insurance benefits is communicated proactively to you.

Does AIM Orthopedics accept my insurance?

We accept most major insurance plans. If insurance payments are the right option for you we will verify your insurance information for Physical Therapy services prior to your arrival. We will provide you with your plan details, including deductibles, co-pays, co-insurance responsibility, and any limitations to your benefit. We will also provide you with an estimated cost per visit.

What if you don’t participate in my insurance plan?

Most insurance companies, with the exception of Medicare and HMO plans, allow members to go “out of network” for health care services. Currently, AIM Orthopedics is an “out-of-network provider” with most major medical insurance plans. Going out of network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. Many patients choose to receive services out of network in order to see the physical therapist of their choice. Please see the section below, “Choosing To Go Out of Network” for more information.

I do not have insurance but need physical therapy. What are my options?

We offer cash rate plans as well as payment plan options for those patients without insurance coverage, or for services rendered outside what your benefits will cover. With direct payment, you schedule as many appointments as you need, when you need them. No waiting for your insurance company, and no referrals needed. With this option, you may be able to save time and recover quicker. Please contact us to inquire about our cash rates and any other options available.

Your health is our number-one priority. As such, we are happy to arrange a payment plan that works with your budget. That way, you can pay for your care over a time frame that works for you. Our compassionate team will assist you with the financial arrangement on your health investment to maximize your benefits. We understand that this can be very confusing. Do not hesitate to call us at 973-814-2246 for assistance.

 

Insurance 101


Additional Information

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To better understand the terms of your plan, you first must understand the terminology. Here are a few common questions regarding insurance terminology:

What is a deductible? This is the total amount you must pay out-of-pocket before your insurance starts to pay. For example, if your deductible is $1,000, then your insurance won’t pay anything until you have paid $1,000 for services subject to the deductible. Just remember, even after you’ve met your deductible, you may still owe a copay or co-insurance for each visit.

What is a coinsurance? This type of out-of-pocket payment is calculated as a percent of the total allowed amount for a particular service. In other words, it’s your share of the total cost. For example, let’s say:

  • Your insurance plan’s allowed amount for an office visit is $150
  • You’ve already met your deductible.
  • You’re responsible for a 20% coinsurance.

In this situation, you’d pay $30 at the point of service. The insurance company would then pay the rest of the allowed amount for that visit. Keep in mind that the coinsurance amount may vary from visit to visit depending on what services you receive.

 

Choosing To Go Out Of Network


“No way can I afford to go to an out-of-network PT…can I?”

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We know the words “out of network” can bring fear and confusion into the minds of most patients. Also, it means you are most likely going to pay more out of pocket for your treatment…right? Not necessarily.

The reason we chose to go out-of-network with most insurance plans comes down to one simple fact:

We want to offer our patients physical therapy treatment the way it was intended to be provided.

Most plans have out-of-network reimbursement. Many people think that if a practice is not in-network with their insurance, they can’t seek treatment there. The truth is we can work with you and your out-of-network benefits. All it means to be in-network is that a physical therapy provider has signed a contract with a health insurance company that allows the insurance company to decide on the value of the physical therapy provided. Sadly, the current climate of physical therapy insurance reimbursement often has providers being paid less than the cost of a personal training session, a massage, even the cost of your last tank of gas.

A few things you need to understand about physical therapy:

  • We have extensive education, training, and are licensed by the state in which we practice.
  • All physical therapy is not created equal. The treatment you receive at AIM is customized, taking into consideration your activities, lifestyle, home and work demands, and even the emotional aspects that relate to your pain and symptoms.
  • All physical therapists are not created equal. Some PT’s further their education by taking continuing education courses and additional training beyond what is required by our governing board. Dr. Lagonigro has over a decade of experience having taking dozens of additional training courses and is currently continuing his education becoming fellowship trained in Orthopedic Manual Physical Therapy at Regis University.
  • All components of physical therapy, from hands-on treatment to exercise, should be delivered by physical therapists. In New Jersey, the terms “physical therapy” and “physical therapist” are protected terms. Only a licensed physical therapist can perform a physical therapy treatment.

We have chosen to stay true to our ideas of how physical therapy should be delivered. We find that our one-on-one 45-60 minute treatment sessions, spent entirely with your physical therapist, allow us to address multiple components of pain and injury, and often expedite treatment.

What’s different?

  • Your PT may structure a different plan of care than used in traditional PT. Do you really need 3 times per week for 6 weeks? Maybe not. Your PT will work with you to develop a plan that will help you recover effectively, while keeping in mind schedule and financial concerns.
  • We expect you to be actively involved in your own recovery. We can’t make you better by ourselves. Most patients will receive a home exercise program to assist in your continued recovery and maintain the gains made in your treatment session.
  • You have access to Dr. Lagonigro via email, phone or text in between appointments if you have questions or concerns.

Please let us know if we can help you learn more about your physical therapy benefits. We look forward to helping you on your path to recovery