We were thrilled to learn about a wonderful new service called Better. This company’s mission is to help patients get the fair insurance reimbursement they serve after paying directly to their provider for out-of-network services. Please follow this link to learn more about how easy, convenient and valuable Better!
We are committed to the highest care for everyone that comes through our door. We are here to serve you and not judge you. If you believe in yourself and are ready to commit to improving your health with us, you are welcome at Shine!
You’ve come in for your first appointment with one of Shine’s skilled physical therapists. What’s next? Patients can sometimes feel overwhelmed about how to effectively schedule their follow-up treatment sessions.
How often should I come in?
The average physical therapy patient at Shine is seen once a week for about 4-12 weeks. However, your therapist will go over an individualized plan of care based on your goals, diagnosis, and your schedule.
What if I need to cancel my appointment?
Shine has a 24-hour cancellation policy. If you have a conflict and need to cancel, please contact our office as soon as possible. Failure to cancel within 24 hours of your appointment will result in a $45 fee.
Can I schedule/reschedule appointments on the patient portal?
You can use the portal to cancel an appointment. However, it does not allow you to schedule your own appointments. We appreciate you contacting the Shine front office directly to cancel or reschedule appointments. This allows our administrative staff to provide you with the personalized attention you deserve and the ability to reschedule your appointment, if needed.
What if I cannot schedule with my therapist in the immediate future?
We will place you on our wait list! Let us know which days and times are most convenient for you. Our staff will do their very best to fill any open slots with patients on the wait list. We will call you immediately when these become available.
Is there anything else I should know about scheduling appointments at Shine?
One last piece of advice: Schedule out several appointments when you are in for your evaluation. This prevents future scheduling issues and ensures a continuous treatment plan.
Having a solid understanding of your insurance policy is important before making any medical appointment. Here at Shine Integrative Physical Therapy, we provide a complementary benefits check for our patients prior to the first visit. To further assist you in deciphering your benefits for our skilled physical therapy services, we've compiled the following terms and concept definitions:
This is the amount you pay for your health care services before your health insurance is required to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met and pid your $1,000 deductible for covered health care services. The deductible may not apply to all services. You will be billed for any deductible owed to Shine within a few weeks of your appointment.
This is your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay the co-insurance plus any deductibles you owe after the insurance has paid its portion. For example, if the plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. In this example, your health insurance pays the remaining $80. You will be billed for the co-insurance within a few weeks of your appointment.
This is a fixed amount (for example, $15) you pay for a covered health care service, when you get the service. The amount can vary by the type of covered health care service. You are required to pay your co-pay at the time of your appointment.
Out of pocket max
This it the highest amount you are required to pay during a policy period (usually one year) before your health insurance or plan starts to pay 100% for covered essential health benefits. This limit must include deductibles, coinsurance, copayments, or similar charges and any other expenditure required of an individual, which is a qualified medical expense for the essential health benefits.
United Healthcare, Blue Cross Blue Shield, Health Net, Care Oregon, Workers Compensation, and Moda plans often require prior authorization for physical therapy services. During your initial visit, you and your physical therapist will create a plan of care. The team at Shine will fill out the required authorization forms based on that plan of care and will then submit this information to your insurance company. The number of visits authorized may be lower than what your PT prescribed but -since we are in-network with these insurers- we must work with what they allow. The Shine team will work diligently to appeal any denied authorization requests and will re-apply for more authorized visits if and when they are needed.
Do I need a prescription?
The state of Oregon no longer requires patients to obtain a prescription for physical therapy services. However, the following insurance plans still require a prescription dated no more than 30 days from the first visit:
All Motor Vehicle Accidents (cannot be from a chiroprator)
Department of Labor
Shine's Billing Process
Claims are sent by your PT through Athena Health who submits them to your insurance company for reimbursement.
Athena Health sends a statement to you after your insurance has processed the claim. This statement will be on your Patient Portal for optional online payment. For payment made in person, we accept cash, check, MC, Visa and Discover.
We hope this brief summary assisted you in understanding the basics of your insurance coverage for skilled physical therapy services at Shine. We are happy to help with your individual questions if you are in need of more specific assistance. Please call or email us at your convenience so there are no hurdles to you receiving the care you need.
By Emily Soiney, PT, DPT, PRC, CST, RYT
Did you know...
- Degenerative changes in the lower back are present in 10% of the population at age 20, 50% at age 40, and 90% at age 60. The majority of people who possesses these changes do not have symptoms.
- In autopsy studies, 100% of the population over age 50 has detectable disc and joint pathology.
- Some degree of disc herniation/protrusion can be found in 50% of the population who have never experienced back pain.
This week, I saw a disproportionately high number of clients at Shine who brought in their MRI or x-ray reports. The scenario is usually something like this: my client -whose symptoms are often much improved- arrives with an uncharacteristic depression about them, handing me these reports with a heavy sigh. Although the client's medical team gave them the key results of the imaging, often the client will still have many questions about and are understandably disappointed by the results. At Shine, we always take time to go through what their results mean with respect to to their function and prognosis. I absolutely love seeing the relief and understanding spread over my client's face when they see this report is not a death sentence.
I too have received horrid-sounding test results and have been told by past physicians that I would not be able to jump, run, or look up without pain EVER AGAIN. Based on the test findings, I can see why they told me these things. Luckily, there is a lot more to living a functional and enjoyable life than what these tests can show us. Thanks mainly to the Postural Restoration interventions I have received, I get to jump, run, and look up when it pleases me. I respect my body went through some tough times and I don't go provoking these areas, but I would have to really push it to notice that "severe arthritis" in my knee or the "broad-based disc bulge effacing the thecal sac of the spinal cord" at C6. I respect that my body -and yours- has lived a full life and has the track record to prove it. That does not mean that you or I have to stop moving and enjoying all the wonderful parts that are still working fine. Thank goodness...
You are not your MRI report!
By Emily Soiney, PT, DPT, PRC, CST, RYT
With the return of great summer weather, many Portlanders our out pounding the pavement. It's about this time of year, that your body reminds you that you still haven't addressed that nagging Achilles tendonitis, knee pain, or plantar fasciitis. Think an orthotic could help?
You may be right since many individuals can benefit from orthotics, but beware: not all orthotics are created equal! Traditional custom foot orthotics are made of rigid plastic and are designed to force the foot into one "ideal" position. They may have been prescribed for you with the best intentions, but often these uncompromising devices can do more harm than good. That's because our feet are made to move and adapt to the ground. Rigid orthotics, as made by most physical therapists and podiatrists and even local shoe stores, do not keep this in mind. When an unforgivingly hard arch support is placed under your foot, it alters everything about how you walk, stand, and even breathe!
Postural Restoration® orthotics were developed by podiatrist Dr. Coffin, D.P.M. and physical therapist Ron Hruska, M.P.T. Not only are they flexible and comfortable, they cost less than other orthotics on the market. Health insurance companies routinely reimburse you for the full cost as well. However, what is truly unique about the Postural Restoration® orthotic is that they are molded by a physical therapist with your sub-talar joint (just below your ankle) in perfect neutrality so the result is a true impression of your foot's "happy place." When the podiatrist fabricates your custom pair, he does not have to guess at where neutral is; this is the case when foam impressions are made in standing.
Postural Restoration® orthotics are designed to work with your individualized foot mechanics and your neurological system to gain the perfect balance of foot stability and mobility. These non-compressible, flexible orthotics are uniquely matched to your posture, gait, and activities. PRI® orthotics not only provide improved outcomes for your feet but will help align your knees, pelvis, and spine to decrease tension and pain. They are best utilized when combining with Postural Restoration® therapies and supportive shoes.
Please contact us to schedule an evaluation and for more information.
Shine's own Emily Soiney, PT, DPT, PRC, CST, RYT was one of five speakers at the Postural Restoration Institute's (PRI) Interdisciplinary Integration Symposium on April 10-11, 2014. Emily delivered a dynamic and practical 2-hour presentation to over 100 therapists, trainers, and coaches. She outlined safe and therapeutic yoga breathing techniques and highlighted similarities between yoga therapy and PRI philosophies. Other symposium topics included PRI Vision, scoliosis treatment, athletic training, and orthostatic intolerance, as well as presentations by a former NASA astronaut and international research legend, Dr. Paul Hodges, PhD. The annual event is held in Lincoln, NE, the home of PRI, which was founded in 1997.
When evaluating a new client at Shine, we often have them bend forward and reach toward their toes. This usually elicits one of two responses: either the person is proud of his or her ability to palm the floor or ashamed of how short his or her hamstrings are. We usually hear stories of how much effort has gone in to trying to lengthen them in the latter group.
The truth is that, when it comes to posture, long hamstrings can be a disadvantage! In fact, we would prefer our clients not to be able to touch their toes on their first visit. I know this sounds like the opposite of what you have always been told. We see things differently...
As Postural Restoration-trained therapists, we know that most patients coming in to Shine with pain are very likely stuck in a painful postural pattern, with one or both sides of their pelvis tilted excessively forward. That position moves the upper attachment site of the hamstrings farther away from the lower attachment site, making them look shorter than they actually are. If you are able to touch the floor your hamstrings may actually be too long!
Your hamstring muscles are vitally important pelvic stabilizers, and if they’re too long it will be harder to get them to respond and do their job. This is something that Postural Restoration training can overcome, but it can take a little longer to "wake these muscles up."
By the end of your Postural Restoration retraining at Shine, you will be able to safely touch your toes without over-stretching any one area. This is one of the goals, but if you start out not being able to, GOOD FOR YOU!
Our most recent reviews had 100% client satisfaction in the following categories:
* Therapists and office staff compassionate and caring attitude
* Improvement from physical therapy intervention
* Plan to recommend Shine to others in need of PT
* Questions answered by therapists
* Ease of scheduling appointments
* Staff Helpfulness
* Facility Comfort