In January 2019, Shine Physical Therapy cancelled our contracts with insurance panels. We have made the tough decision to opt-out of working as “preferred providers” after 10 years because of the worsening trend of reduced access to our care by these insurance companies. Starting in early spring 2019, Shine will be only taking direct payment for our services. Although any major change can feel challenging at first, we are very optimistic that this will better serve our clients and serve our Shine community at our highest potential. We are here to help you navigate this transition and appreciate your support.
We have worked through all of the details for this transition, so sit down, keep breathing and read on.
From a payment standpoint, there are a number of benefits for our clients:
1. For our many clients with high deductibles, you will actually pay less than you would with an '“in-network” provider. The insurance company’s dictate a “usual and customary” fee schedule which means they will charge you significantly more than Shine will until and once you meet the deductible. All payments to Shine will be documented with a specific receipt, called a Super Bill, that you can submit to your insurance as credit towards your deductible. This will mean savings for you with the same exceptional care at Shine.
2. For everyone with insurance coverage, we will no longer be subject to excessive restrictions and limitations from non-health care providers who have never met you and want to dictate your care. To assist you, we will provide a basic form for you to check important aspects of your insurance coverage, including if your insurance requires (prior) authorization for PT services. This authorization will may dictate whether your insurance will honor the Super Bill and credit you for your payments. Therefore, if applicable, Shine will submit the required authorization paperwork for your care for a nominal fee. This fee will be required every time a new authorization is required and Shine is not responsible for insurance’s lapse in authorization and subsequent non-acknowledgement of your visit’s payment.
3. We have partnered with GetBetter.com to support you getting the credit or re-imbursement for your care. For a nominal percentage, they will assist you in obtaining all credit and/or reimbursements for your visits at Shine.
4. Opportunities such as Care Credit can help you finance your care.
5. We will continue accepting FSA and HSA for payments so that you can use your tax-deferred accounts for your care.
As early as March 1, but will depend on your specific insurance company’s response to our discontinuation letter, fees will be reduced as a courtesy during this transition time to $140 per hour. Beginning July 1, 2019 rates will be $160 per hour.
Your visit will continue to be one hour with no aides, equipment or other “fillers” like at most clinics. You will continue to have our full support outside of your appointments with email or phone call responses to your questions.
The best silver lining from this change will be the freedom to provide more care that is not covered by insurances including novel treatments and Telehealth options. We know that many of our clients require preventative and maintenance treatments as well as visceral and craniosacral therapies that Medicare does not cover. With the reduction in administrative workload, Dr. Emily will be able to see more clients and hopes to reduce the wait times for new clients as well.
Some new offerings include:
Two therapist treatments: $220 per hour
Telehealth sessions: $40 for 20 minutes
Review your home exercises, fitness routine, desk set-up, or just check-in with us from the convenience of your phone or tablet’s app.
Telehealth fitness routine: $60 for 30 minutes
Work out with your therapist from the convenience of your home.
Finally, we will offer self-scheduling on a trial basis. our hope is that this will facilitate easier scheduling for our clients.