Insurance at NYDNRehab Clinic

Does My Health Insurance Cover Physical Therapy?

Out-of-Network Insurance Benefits

Since we are an out-of-network healthcare provider, your insurance reimbursement is based on your insurance plan’s terms of coverage, including co-pay, deductibles, and co-insurance. Our staff is always happy to review your plan’s benefit provisions with you.

As a professional courtesy, we will verify your benefits and submit a claim to your insurance company on your behalf. Once your out-of-network coverage has been determined, your insurance company will reimburse you directly.

In-Network vs Out-of-Network Coverage

Most In-Network insurance providers will only pay on average for 15 minutes of one-on-one physical therapy per session. Typical out-of-pocket copay is around $30. In addition to your co-pay, you will be responsible for sessions that exceed 15 minutes. For example, if you have a one-hour session, you will pay the $30 copay, plus payment for 45 minutes of treatment. Your insurance company will reimburse you for the remaining 15 minutes.

Convenient Payment Plans

Patient health is our priority. We are more than happy to structure a payment plan for your treatment that works with your budget.

No Referral Needed

In New York State, physical therapy patients do not need a referral from a medical doctor to access physical therapy services. That means you can still make insurance claims for treatment, even if you have not been referred from another source.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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