• Understanding Insurance Coverage
• Insurances Accepted
• General Questions on Eligibility
• Glossery of related Medical Terms

Understanding Insurance Coverage 1. How do I know what my physical therapy coverage is?    Most people obtain their health insurance through their employer. Some employers offer a choice of health insurance plans, such as coverage from a health maintenance organization (HMO) or a preferred provider organization (PPO). Different plans come with different benefits, restrictions, deductibles (the amount you must pay before your plan pays) and co-payments (the amount you pay at the time of your visit).    Because hospitalization, pharmaceuticals, and dental care typically are of primary interest to employees, employers may select health plans based only on those areas. Too often, people Ed to express interest in physical therapy benefits until they need them. As a health care consumer, however, you should examine your plan's physical therapy benefit language to see what's covered. What is benefit language?    Benefit language defines who's eligible for care, how much care that person can receive, and the timeframe within which it can be rendered. The language can be either very restrictive or all-inclusive. For example, a health plan's physical therapy benefit may limit treatment of chronic conditions, by a physical therapist; this could restrict patients    diagnosed with cerebral palsy, multiple sclerosis, or rheumatoid arthritis from receiving all the physical therapy they need.    Some plans may place a cap on the number of physical therapy visits a patient may make and may specify that the visits take place within a specific timeframe. It's important to read your plan's physical therapy benefit language carefully to determine if the visit limit is "per condition," "per calendar year," or "per episode of care" (the period from initial contact with a physical therapist, or PT, through discharge).    Other plans may require "pre-authorizaLion" for more than a small number of visits for any condition, or a doctor's approval before you can even see a PT And some plans require that their own reviewers determine, in each case, whether the medical necessity has been supported by the PT's documentation. What if I am denied extended coverage for physical therapy?    Most health plans have three or four layers of appeal if benefits are denied. You can call the health plan's member services department for an explanation of the entire appeals process.    If your PT thinks you'll need a certain number of visits, he or she should discuss the case in advance with your health insurance provider. The PT may be able to obtain preauthorization for anticipated care based on his or her assessment of your initial examination. Supporting letters from referring physicians also are helpful.    If you f1eel your case isn't being fairly reviewed or considered, you might discuss the issue with your employer's benefits manager. It may be that your employer isn't even aware of how restricted the physical therapy benefit is. If that's the case, you'd do well to heighten your employer's awareness of the physical therapy language, which frequently is drafted by the insurance company or broker. What other options do I have?    At the time you schedule your first physical therapy appointment, your PT should find out what benefits are available to you. After your examination, he or she will be able to forecast the treatment you'll need and its timetable. If it appears that your insurance won't cover needed therapy, your PT will go over your options with you.    One option you should strongly consider if your insurance won't cover the physical therapy you need or want is to pay for it yourself. Physical therapy confers a wide range of benefits-from preventing injury to restoring function-and IYTs offer expertise in such areas as safe exercise and userfriendly home and workplace design. In most states, you don't need a doctor's approval to see a PT if you're paying out of pocket. (For a list of "direct access" states, visit the American Physical Therapy Association's Web site at wwwapta.org/Advocacy/ state/directaccess/State3.) You pay for vitamins, gym memberships, massages, and yoga. Why not physical therapy-one of the best things you can do for your personal wellness? Rhea Cohn, PT, AM, is Associate Director, Department of Reimbursement, at the American Physical Therapy Association. She can be reached via e-mail at rheacohn@apta.org.  print topic

Insurances Accepted Medicare Humana CIGNA PPO AETNA First Health United Health Care BCBS Beech Street Mail Handlers L.O.P.'S Auto/Liability Workers/Compensation Call and we'd happy to verify your coverage. 1.386.756.0077

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General Questions on Eligibility 1. Who is eligible for rehabilatition? Anyone who has suffered a traumatic brain injury, stroke or some illness that has affected the brain. 2. Does the patient have to have been in the hospital in order to be a candidate for UR Rehab? No, an appointment with your Physican can assist the patient in becoming a patient. 3. How do we go about getting a person evaluated for the rehabilitation program at UR Rehab? The number to request an appointment with one of the Physiatrists at UR Rehab is 444.444.4444. 4. How many doctors see the patient at UR Rehab? Any MD can follow a patient. The Physiatrist is the attending physician and he can consult any physician needed. If the patient's primary care provider would like to follow, temporary privileges can be easily obtained. 5. Who decides when a patient is ready to go home from UR Rehab? The rehab team which includes Physiatrist, Case Manager, Registered Nurse, Social Worker, Physical Therapist, Occupational Therapy, Speech Therapy, Psychology as well as input from the insurance company. 6. What does the therapy consist of at UR Rehab? Physical Therapy and/or Occupational Therapy, Speech Therapy, Recreational Therapy, Psychology- Each consist of a morning and afternoon treatment session totalling x hours of therapy per day. 7. How do I know if my insurance company covers UR Rehab? Our Patient Care and Billing Coordinator take care of finding out eligibility for each patient. A phone call to the customer service line for your insurance can also give this information. 8. Who keeps in contact with my insurance company? There is a Case Manager in charge of each persons case who follow the patient from a medical and rehab perspective. 9. My family member's personality is different from before the accident, is this normal? Yes, certain parts of a patient's personality my be magnified and as healing occurs, personality changes will continue. 10. What is the follow-up provided by UR Rehab when the patient leaves the hospital? The social worker will set up appropriate follow up therapies either in a home care, out-patient or Day Institute program setting. There will also be a follow-up appointment in one month from diagnosis with the Physiatrist. 11. What kind of education is provided for patient families at UR Rehab? There is an education series every xxxxx and xxx afternoon beginning at x: xx p.m. Professionals from UR Rehab will be available to answer questions at any time.  print topic

Glossary of Medical Terms ADL: Activities of daily living (dressing, bathing, etc.) AFO:Ankle-foot orthosis; a short leg brace Abnormal Muscle Tone: A disturbance in the amount of tension normally found in a muscle. The tension may be abnormally increased (hypertonicity or spasticity) or abnormally decreased (hypotonicity or flaccidity). Abstract Reasoning: Higher level thinking and problem-solving. Adaptive Equipment: Any device used for the purpose of improving one's ability to perform a task. Agitation:Restlessness and increased activity often associated with anxiety, fear, and tension. Ambulate:to walk Aphasia: Inability to express or understand ideas in any form due to brain injury. Expressive aphasia: Inability to express oneself even though one knows what to say. Receptive aphasia: Inability to understand spoken language. Apraxia: Partial or complete inability to carry out a planned, purposeful sequence of movements, in the absence of paralysis, sensory changes or deficiencies in understanding. Articulation:Production of speech sounds. Aspiration:A swallowing problem when food, liquid, or secretions enter into the lungs. Assistive Device: Special or modified equipment which assists a person to independently perform a task. Examples include canes, special eating devices, non-vocal communication devices, etc. Ataxia: Interruption of smooth muscular movements, characterized by uncoordination. Attention Span: The length of time a person can concentrate on a task or event. Audiology: Study of hearing or hearing disorders and the testing of hearing. Bed Mobility: Ability to move oneself on a mat or bed, by rolling, sitting or lying down. Bilateral: Both sides (of the body). Blood Pressure: The pressure exerted by the blood on the wall of any blood vessel. Biofeedback: A process in which information is recorded from the patient and then relayed back to that individual so that he can change a particular state, such as muscle tone or position. Catheter: A tube for draining urine. Clonus: A sustained series of rhythmic jerks, usually seen in ankles or wrists, caused by the quick stretching of a muscle. Cognitive Retraining: Developing or relearning the process involved in thinking. Coma: An abnormal deep sleep occurring in illness or as a result of injury in which the patient cannot be aroused by external stimuli. Comprehension: The ability to understand or draw meaning from what is seen (visual comprehension), heard (auditory comprehension), or touched (tactile comprehension). Concrete Thinking: The individual is unable to understand the similarities between situations, seeing each situation as different; language is interpreted literally. Inability to think abstractly. Confabulation: Speaking about imaginary experiences to fill memory gaps. Confusion: The state of being "mixed up" relating to time, place or person. Continence: Ability to control bowel and bladder function. ContragroupOccurring on the opposite side. A contragroup is an injury to parts of the brain located on the side opposite the primary injury. Contracture:Loss of joint motion; stiffness. Contusion: An injury in which the skin is not broken as in a bruise. Coup: Occurring on the same side. A coup injury is an injury to parts of the brain located on the same side as primary injury. Craniectomy: Surgical opening of the skull and removal of a portion of the skull. Craniotomy: Surgical incision into the skull. Decubitus: A localized breakdown of all skin layers (commonly called bed sores). Dysarthria: Unclear, slurred speech resulting from weakness and/or uncoordination of the muscles used to produce speech. Echolalia: Tendency for an individual to repeat that which is spoken to him. Edema: Swelling of any part of the body due to collection of fluid in tissue. Electrical Stimulation: Direct application of mild electricity to a muscle or muscles to cause them to contract. Emotional Lability: Involuntary, uncontrolled laughing or crying. Extension: Usually means to straighten a joint, as in straightening your knee. Fine Motor Activities: Activities involving small complex movements such as writing and manipulating small objects. Flaccid: Lacking muscle tone; flabby. Flexion: Usually means to bend a joint, as in bending your elbow. Focusing: Directing attention to visual or auditory stimulus. Functional: Ability to use skills in a useful or productive way. Gait Training: Instruction in walking, with or without equipment; also called ambulation training. Gastrostomy Tube (G-Tube): A feeding tube passed directly into the stomach from a surgical opening in the abdomen. Head Control: The ability to maintain the head in an upright position. Hematoma: A swelling or mass of blood (usually clotted) confined to an organ, tissue, or space and caused by a break in a blood vessel. Hemianopsia: Loss of half the visual field in one or both eyes. Hemiparesis: Lack of muscle control on one side of the body. Hemisphere: The brain is divided into two halves: right and left, each with localized functions. Right Hemisphere: Controls left side of body. Generally controls visual-spatial functions, logic, judgment, and organization of tasks. Left Hemisphere: Controls right side of body. Generally controls speech and language functioning. Hydrocephalus: The collection of serous fluid in the head; edema of the brain. Hypertonic: Abnormal increase in muscle tone or tension. Hypotonic: Abnormal decrease in muscle tone, or relaxation. Hypoxia: Lack of an adequate amount of oxygen in inspired air. Impulsivity: Performing an action before thinking about the consequences. Incontinence: Inability to retain urine, or feces due to loss of sphincter muscle control. Independent: Ability to perform an activity consistently and safely, in a practical amount of time, without supervision or assistance. Jargon: Continuous unintelligible speech. Jejunostomy (J-Tube): Surgical creation of an opening into the jejunum (portion of the small intestine) for the purpose of feeding tube placement. Memory: The process of recalling or reproducing what has been learned and retained. Short Term: Recalling information up to 24 hours. Long Term: Recalling information over a long period of time. Motor Planning Problem: Difficulty starting, continuing and stopping movements when there is no actual muscle weakness or damage. May affect speech or movement of the arms or legs. Also referred to as apraxia. Nasogastric Tube (NG Tube): A tube which is passed through the nostril and into the stomach to carry food directly to the stomach. Neglect: The difficulty to respond and react to things in the environment, often on one side of the body. Non-Purposeful Movement: Movement of any part of the body which has no apparent function. Nystagmus: Involuntary movement of the eyeball. NPO: A medical abbreviation for a physician's order that the patient is to receive "nothing by mouth." Orthotics: Braces Orientation: Acute awareness of self, other people, time and place. O.T.: Occupational Therapy Paralysis: Inability to move a muscle or group of muscles voluntarily. Paresis: Weakness of a muscle or group of muscles; partial or incomplete paralysis. Perception: Ability to recognize and distinguish objects in the environment, including size, shape, color, and distance. Perceptual Motor:Interaction of vision with motor (muscular) activities such as eye-hand coordination, eating, picking up objects, etc. Perseveration: Uncontrolled, involuntary repetition of speech or activity. Phonation: Production of sound caused by vocal fold movement. Physiatrist: A medical doctor specializing in physical medicine and rehabilitation. Plateau:> A continued absence of significant improvement. Positioning: Arranging and placing patient's body and limbs so as to prevent skin breakdown and maintain flexibility. Postural Draining: Technique by which secretions are prevented from building up in lungs and airway or area assisted in draining from lungs and airways. Pressure Area: A discolored area of skin caused by continuous pressure which could eventually develop into a decubitus or bed sore. Premorbid: Patient's condition before the injury. Problem Solving:Ability to reason and plan. Prone: Lying face down. Proprioception: Positive sense; appreciation of position, balance, and changes in equilibrium of a body part during movement. P.T.: Physical Therapy Purposeful Movement: Intentional movement controlled and directed by the patient. Quadriparesis: Lack of control of all four limbs of the body resulting from an injury to the brain. Seizure: A wide ranging series of rapid body movements, twitching and jerking, with or without loss of consciousness. Also referred to as a convulsion. Semiconscious: Not completely aware or responsive. Sensory Stimulation: Arousing the brain through any of the senses. Spasticity: A marked tone, characterized by hyperactive reflex resistance to passive movement, clonus and shortening of the muscle. Splint: A plastic support used to position one or more joints properly to reduce muscle tension, increase range of motion and/or allow greater use of the body part. Spontaneous Response: Automatic responses, response occurring free of will. Strabismus: Uncoordinated movement of the eyes, usually resulting in double vision. Structure: To simplify a task, an activity, information and the surroundings. Subluxation: A partial or incomplete dislocation of a joint. Suctioning: Removal of mucous secretions from air passages by an external device. Supine: Lying on one's back. Synergy: Combined action of two or more joints to form an abnormal pattern of movement. Tactile Defensiveness: The quality of being unable to tolerate touch, resistive and uncomfortable at certain kinds of touch. Tone: The tension of resting muscle and the amount of resistance that is felt when a muscle is moved. T.R.: Therapeutic recreation. Tracheostomy (Trach): A surgical opening at the front of the throat providing access to the trachea or windpipe. Tracking: The ability to follow moving things with the eyes. Transfer: Refers to methods of getting to and from a wheelchair, bed, toilet, etc., using a stand-pivot movement or a sliding board. Tremors: Involuntary trembling of a part of the body. Vocal Folds (Vocal Cords): Long bands of muscle tissue found in the larynx (voice box). When they vibrate, voice is produced.