Experience The Best Specialized Pelvic Floor Physical Therapy at Chicago Pelvic
Start Your Path to Pelvic Health with Chicago Pelvic's Expert Patient Focused Physical Therapy
Chicago Pelvic: Navigating Out-of-Network Pelvic Floor PT with Confidence
At Chicago Pelvic, we pride ourselves on providing exceptional, specialized pelvic floor physical therapy that exceeds traditional in-network limitations. We recognize the unique advantages of out-of-network physical therapy (PT) for those seeking personalized specialized care given by Expert Pelvic PT Doctors. Here’s a comprehensive guide to understanding and utilizing out-of-network PT services with us:
Understanding Out-of-Network Pelvic Health Physical Therapy
Out-of-network PT means receiving care from specialized therapists who are not in binding contracts with your health insurance company. This option is particularly valuable when seeking highly specialized treatments, such as pelvic floor therapy, that may not be widely available within in-network providers. Although out-of-pocket costs may initially appear higher, out-of-network care often leads to more personalized treatment, access to specialized expertise, and reduced number of visits required to meet our pelvic patient goals.
The Benefits of Choosing Chicago Pelvic’s Out-of-Network Model Focused on Patient Care First!
Specialized Pelvic Health Care: Access to our Board-Certified Doctors of Physical Therapy for all patient care, ensuring personalized and direct treatment. This policy guarantees that every session is led by the top expert in pelvic therapy, providing consistent, high-quality care tailored to your needs. Our commitment to a direct doctor-to-patient approach enhances treatment effectiveness and fosters better outcomes.
Personalized Treatment: Our out-of-network model allows for longer (1 hour vs Avg of 30-45mins), uninterrupted sessions tailored to your specific needs, in a private and comfortable room, without the constraints of insurance limitations.
Direct Access: At our clinic, thanks to direct access legislation, you can get therapy without needing a referral, streamlining your journey towards recovery.
Flexibility and Control: Enjoy the freedom to choose your therapist and clinic based on expertise and personal preference, not just the network restrictions.
Dedicated and Private Care Commitment: Our approach to treatment prioritizes your privacy and dedicated care. We ensure that each session is focused solely on you, avoiding in-network practices like multitasking with other patients while we have you warm up on a treadmill, using heating pads as time fillers in order to treat others, or conducting sensitive exercises in open gym spaces around others. Our team is committed to providing personalized, doctor led, one-on-one care without relying on assistants or aids, ensuring your time with us is productive and private.
Making Informed Decisions for your Health
Out-of-Network Benefits: Investigate your insurance plan’s out-of-network coverage to understand reimbursement rates and potential out-of-pocket costs. Our team can assist in verifying your coverage and explaining the financial aspects of your care. We can also assist in receiving “In-network waivers/ GAP Coverage” from your insurance company.
Freedom of Choice: Opting for out-of-network care at Chicago Pelvic means not being confined to a limited selection of providers who are typically not certified in pelvic health, ensuring you receive the best possible expert pelvic floor treatment for your condition or concern.
Comprehensive Coverage: While insurance may cap the number of in-network visits, out-of-network care often allows for more extensive treatment without the worry of premature discharge due to benefit limitations, or the insurance company not validating your pain and concerns.
Important Considerations
Higher Out-of-Pocket Costs: It’s true that out-of-network services typically incur higher upfront costs, but the investment in your health often yields unmatched personalized care and expertise.
Insurance Reimbursement: Reimbursement rates and timelines can vary for out-of-network services. We recommend discussing payment arrangements upfront to manage expectations and budget accordingly.
In-Network Waivers: Due to the unique nature and requirements for Pelvic PT, a lot of our patients receive “In-Network Waivers” or “Gap Coverage” to get coverage based on their in-network benefits. This is in large part because certified pelvic PTs are not as commonly available due to the specialized nature of their work. Please fill out our contact form to receive any documents necessary or to learn more. Details below….
Why Chicago Pelvic for Out-of-Network PT vs an In-Network Clinic
Choosing Chicago Pelvic for your PT needs ensures access to a team of specialists dedicated to delivering life-changing care. Our model is designed to prioritize your health and recovery, offering:
Tailored Sessions: From advanced manual techniques to holistic treatment plans, our sessions are crafted to address your specific health goals.
Concierge Experience: Beyond therapy, our team offers unparalleled support, including assistance with insurance queries and guidance on navigating out-of-network benefits.
Direct Billing and Transparency: We provide detailed billing statements for insurance reimbursement and clear upfront communication about all costs involved in your care. No surprise bills months later.
Embrace the Chicago Pelvic Advantage
Deciding to go out-of-network with Chicago Pelvic means prioritizing your health, receiving specialized care, and benefiting from a holistic, patient-centered approach. Our commitment to excellence and patient advocacy ensures that you’re not just another case but a valued member of the Chicago Pelvic family.
For those navigating the complexities of out-of-network benefits, we’re here to help. Contact us to discuss your options, verify your insurance benefits, and take the first step towards personalized, specialized pelvic floor physical therapy at Chicago Pelvic.
Understanding Your Rights to Out-of-Network Care: Time, Distance, Gender, and Specialized Services Requirements
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Certified Pelvic Clinic Care
Insurance companies are required to keep an updated list of specialties for in-network clinics, ensuring that patients have access to a wide range of specialized care. If you need Pelvic Floor Therapy and your regular physical therapy (PT) clinic doesn't offer this specific treatment, you may face a challenge. Not all PT clinics have specialists trained in Pelvic Floor Therapy, which is crucial for treating pelvic floor dysfunction. If your insurance company‘s list of in-network providers does not include a clinic with a certified pelvic floor PT specialist, you should be eligible for an in-network waiver. This waiver allows you to receive care from a specialized provider outside of your insurance network, ensuring you get the necessary treatment for your condition or concern.
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Distance Requirements
Insurance companies also have guidelines regarding the maximum distance you should travel to see an in-network provider. If the nearest provider is beyond this distance, you may qualify for a waiver to see a provider outside of their network. This is designed to ensure that getting the care you need is not only timely but also conveniently located. For example, specific PPO policies state that the furthest you should have to travel to an in-network clinic is either a 20-minute drive or 10 miles. If no in-network providers are within your plan’s range, you might be eligible for a waiver to choose a different provider, even if they are out of the network.
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Time Requirements
Most insurance companies have rules about how soon you must be able to get an appointment with a provider in their network. If you can't get an appointment within a specific timeframe, the law allows you to get a waiver. This waiver lets you choose a provider outside the network for your care. For instance, some plans requires that you get an appointment for routine specialty care within 14 days.
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Gender Specific Services
If an in-network clinic does not offer treatment services specifically for men or women, you might be eligible for an "in-network" waiver. This means if the clinic's services don't meet your gender-specific healthcare needs, your insurance may allow you to choose a provider outside the network who can provide the appropriate care.
How much does Pelvic Floor Physical Therapy Cost? (2024 Prices)
Pelvic Floor Evaluation $275
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Your evaluation begins with a private and confidential conversation in a comfortable setting, where you'll discuss your medical history and current pelvic floor concerns with your therapist. This essential conversation allows your therapist to comprehensively understand your condition, enabling the creation of a customized treatment plan aligned with your unique needs and goals.
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Following the initial conversation, your therapist will conduct a physical assessment of your body to identify areas of discomfort or pain. This assessment also includes an examination to observe how your body moves. They will then conduct an external examination of your pelvic region.
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Should it be necessary and with your explicit consent, your therapist may perform a physical internal examination of your pelvic floor. This assessment is conducted on a comfortable bed, ensuring you are fully covered with clean sheets and supported by soft pillows for your ease. Throughout the examination, your therapist will maintain open communication, explaining the nature of your symptoms and their possible causes to enhance your understanding and comfort.
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After completing the physical evaluation, your therapist will explore treatment possibilities tailored to your specific requirements. This could encompass suggested exercises, stretches, or various therapeutic approaches. You may be encourage to track your symptoms to observe your progress over time. Together, you and your therapist will craft a personalized treatment strategy aimed at reaching your goals and enhancing your quality of life.
Pelvic Floor Treatments $225
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Your therapist will start by asking for your feedback on any changes in your symptoms since the initial evaluation. This includes improvements, worsening, or the emergence of new symptoms. Your feedback is crucial for tailoring the treatment plan to your needs.
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Depending on your feedback and the treatment plan, your therapist may perform a brief physical examination to assess changes in muscle tone, strength, and any specific areas of concern identified during the initial evaluation.
If exercises or specific skills were prescribed during the initial visit, your therapist might evaluate your technique and the effectiveness of these exercises. This ensures that you are performing them correctly and benefiting from them as intended.
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Based on your feedback and their clinical assessment, your therapist will adjust the treatment plan. This could involve introducing new exercises, modifying existing ones, or incorporating different treatment modalities like manual therapy, dry needling, and many more options.
Your therapist will also continue to provide education on pelvic floor function, lifestyle adjustments, and home exercise programs. This education aims to empower you with knowledge and tools to manage your condition effectively.
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Together you and your therapist will collaboratively set short-term and long-term goals for therapy. These goals are based on your priorities, such as reducing pain, improving bladder control, or returning to specific activities.
Packages Available
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Chicago Pelvic's Ultimate Guide to a Confident Pregnancy and Birth Package
1 Pelvic Floor Evaluation
Pelvic Floor Evaluation from your Doctor of PT to assess your current health and prepare for the birth of your child.
3 Treatments Sessions
You will receive 3 treatments spread across your pregnancy and postpartum journey. Our Board Certified Doctors will cover birthing positions, ways to reduce labor length and tearing, how to push, and exercises to keep you strong.
Birth Like a Boss Book
A guide written by Dr Jana Richardson, PT, DPT, WCS, PRPC, CIDN to help prepare you for the best possible outcomes throughout your birthing experience.
Post-birth Check-in
Receive a personal phone call within the first 2 weeks of giving birth from your doctor. She will check in with you and provide some pelvic PT guidance before your first in-person postpartum treatment session.
Birth Prep Swag Bag
Receive a gift bag with carefully curated items to help soothe and relieve some of the most common pelvic concerns.
Pelvic Peace of Mind
Don’t stress about those “mom scaries.” Chicago Pelvic has you covered with the preparation needed for the best outcomes and the peace of mind knowing you have someone to turn to throughout the whole process.
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We offer a package of 6 visits to reduce cost for our patients committed to resolving their concerns with Chicago Pelvic. This is a savings of $100 directly to the patient.
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(Coming soon)
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(Coming soon)
All packages are reimbursable through both in-network or out-of-network insurance coverage, depending on your specific coverage details
FAQ for Filing Insurance Claims
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We have partnered with Reimbursify to assist in determining your insurance benefits and helping you file claims too. Please follow the below link to check your benefits! Don’t forget to include your contact number for a faster response.
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Yes, we provide a “Superbill” (An invoice showing paid in full with insurance information noted) after each visit with our doctors. We can also provide other commonly requested documents needed for reimbursement.
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Yes, we encourage the use of HAS/FSA cards. We also except all major credit cards and cash.
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We are currently not contracted with Medicare or Medicaid, and we are thus unable to see you as a Medicare or Medicaid patient. Please read the below link for more information. ttps://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance
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The below will help to clarify the process regarding insurance documentation and our role in facilitating your healthcare needs with insurers, specifically, BCBS, United, Aetna, and Cigna. We assure you that all requisite documentation for Chicago Pelvic Health has been meticulously provided.
Should you require them, we are more than willing to provide PDF copies of your superbills or medical notes via email, which encompass clinic and medical details from any prior appointments.
Please understand that while we are fully committed to supporting your healthcare journey, our clinic's policy does not encompass direct communications with insurance companies. However, we are open to addressing any queries or concerns via a direct phone call from your insurance company.
It is essential for all necessary information exchanges to occur directly between you, the insured party, and your insurance provider. As an external entity, our capacity to interact with insurance representatives is severely limited. We also wish to inform you that any requests from your insurance representative for us to engage in registration, forms completion, or credentialing processes are not standard procedures. Such requests may unfortunately result in unintended delays in your care.
Please reach out if you have any questions! Thanks!
LEARN MORE ABOUT YOUR INSURANCE RIGHTS IN ILLINOIS
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The Network Adequacy and Transparency Act (215 ILCS 124) establishes several key requirements and protections regarding the use of out-of-network clinics and providers, the obligations of insurance companies to provide information to patients, and the provision of specialty care. Here’s a summary focused on those aspects:
Coverage for Out-of-Network Services:
The Act recommends that if a beneficiary makes a good faith effort to find in-network providers but cannot due to insufficient network coverage, unreasonable distance, or wait times, the insurer must cover the out-of-network service at no additional cost to the beneficiary compared to in-network services (Sec. 10, Paragraph 6).
Insurance Companies' Information Provision Requirements:
Provider Directory: Insurers must maintain accurate, up-to-date online and printed provider directories, including information about providers' specialties, office locations, whether they are accepting new patients, and the use of telehealth or telemedicine. These directories must be accessible to both beneficiaries and the general public without requiring a login, and updated at least monthly (Sec. 25).
Emergency Services:
Insurers must cover emergency services at the same level as in-network services, regardless of the provider's network status, ensuring no additional cost to the beneficiary (Sec. 10, Paragraph 7).
Distance and Time Requirements:
The Act specifies that insurers must demonstrate how their network provides reasonable access to healthcare services, including maximum travel times and distances for beneficiaries, which are established annually by the Department in consultation with the Department of Public Health (Sec. 10, Subsection d).
Continuity of Care:
In cases where a new beneficiary has an ongoing course of treatment with a non-network provider, the Act provides mechanisms to continue receiving care from that provider under certain conditions, ensuring transitional care without immediate disruption (Sec. 20).
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Please visit the link below to learn more.
tps://idoi.illinois.gov/