We don’t play the insurance game
And that’s exactly why. It’s because it’s a game. I am not okay with your insurance company deciding what kind of care I can provide to you. They’re not paid to care about you or your goals. Healthcare is broken and it can be a much better investment of your time and money to deal with a real human, especially for something as intimate and important as your pelvic health.
Occupational therapy is direct access in California and you do not need a referral to receive services. If you are using out-of-network benefits, it’s possible that your insurance company will ask for a referral from a physician.
Soft Power does not have active contracts with any insurance companies, but I can provide you with a super bill if you have out-of-network coverage. Credit card, cash, and HSA payments are also accepted at the time of service. I do not directly communicate with insurance companies, so it is your responsibility to understand your benefits and submit the paperwork they require for reimbursement. Check out Reimbursify to help navigate out-of-network coverage for occupational therapy.
I legally cannot see Medicare or Medicaid/Medi-cal patients for pelvic floor therapy due to limitations built into the system.
But why is out-of-network pelvic floor therapy better?
Pelvic floor therapy addresses a wide variety of symptoms that often aren't prioritized by insurance companies. Not accepting insurance means I can offer personalized, hour long sessions that focus entirely on you, your goals, and your symptoms. This allows me to treat all aspects of your health without being limited to just one body part or specific diagnosis due to insurance restrictions. In insurance-based practices, therapists often need to see multiple patients at once and you might be passed around between different therapists, assistants, and aids who don’t know you or your full story. It’s not their fault! It’s because insurance reimbursement rates are low and the system is failing everyone.
In this cash-based model, we can work together to create a care plan that fits your schedule and budget. I respect your time and will never recommend more appointments than necessary to help you achieve your goals. With price transparency, you’ll never face unexpected bills due to insurance denials that can be very common in pelvic health. While paying out-of-pocket may seem like a bigger up-front investment, we’ve found that a lot of folks might actually pay less overall to work with cash-based providers. High co-pays, high deductibles, and treatment plans that expect therapy 2-3 times a week can make insurance-based services the less affordable option. With my expertise, your sessions will be efficient and highly-focused, so you’ll likely need fewer visits overall.
How to know if you have out-of-network benefits
Your insurance company’s phone number should be on your insurance card. You can call that number and speak to a representative to ask if you have coverage for out-of-network occupational therapy. You can ask about your out-of-network deductible and what percentage of the total they will reimburse for occupational therapy services. You can also ask about in-network waivers if this type of specialized care is not available in-network or within a reasonable time frame. There can be long waitlists for specialty providers who are contracted with insurance companies.
If they ask for CPT codes, you can say:
97166
97110
97112
97140
97530
Reach out if you have questions and we will do our best to help! You can also use Reimbursify as a patient to help understand your benefits and manage out-of-network insurance claims so your reimbursement process is less of a headache.
