What Should I Expect During a Visit?
Evaluation and treatment will be performed interchangeably during your first session, so you get results on Day 1. Each following visit will also be intertwined with reassessment and hands-on treatment to help your body move normally without pain. You should feel results each session.
After your evaluation and first day’s treatment, your therapy frequency and duration of care will be determined. Due to our approach and intensive focus on the patient, it takes fewer visits to resolve injury and dysfunctions than at traditional clinics. Every patient is different and so is the treatment, but most people will benefit from 1-2 sessions a week at most for 4-6 weeks at most.
After your evaluation and first day’s treatment, your therapy frequency and duration of care will be determined. Due to our approach and intensive focus on the patient, it takes fewer visits to resolve injury and dysfunctions than at traditional clinics. Every patient is different and so is the treatment, but most people will benefit from 1-2 sessions a week at most for 4-6 weeks at most.
What Should I Wear and Bring?
Please wear loose-fitting clothing or athletic clothing so that your targeted area can be assessed. Also, please do not wear copious amounts of lotion. These area will have to be cleaned with alcohol for manual therapy or dry needling.
Bring your new patient paperwork.
Bring your new patient paperwork.
How Can Dry Needling Help Me?
Do you want to have less pain, have more flexibility, be able to sleep better, or have more mobility with daily activities? Dry Needling may can help you!
If you have chronic tightness or acute spasms from a recent injury, dry needling may be able to relax those muscles and help you move normally again. Patients have seen relief in chronic back pain limiting sleeping and bending, hamstring immobility limiting exercise, shoulder pain limiting reaching, tingling down the arms from cervical tightness, and post-surgical Achilles tightness limiting walking to mention just a few people’s stories who have been helped by Dr. Duggan’s dry needling.
Have you had a muscle that seems to have shut off? Patients have also received benefit from functional dry needling through improved muscle activation. For example, patients have experienced cessation of back pain post-partum that was caused by deep back stabilizers shutting off from the stress of child birth. Dry needling to those muscles caused them to activate again, improved the body's awareness of those muscles, and improved the normal use of the muscles again.
Dr. Duggan will assess you on evaluation and discuss with you if dry needling will be beneficial for you.
For more details please see the link below to read more on our blog.
If you have chronic tightness or acute spasms from a recent injury, dry needling may be able to relax those muscles and help you move normally again. Patients have seen relief in chronic back pain limiting sleeping and bending, hamstring immobility limiting exercise, shoulder pain limiting reaching, tingling down the arms from cervical tightness, and post-surgical Achilles tightness limiting walking to mention just a few people’s stories who have been helped by Dr. Duggan’s dry needling.
Have you had a muscle that seems to have shut off? Patients have also received benefit from functional dry needling through improved muscle activation. For example, patients have experienced cessation of back pain post-partum that was caused by deep back stabilizers shutting off from the stress of child birth. Dry needling to those muscles caused them to activate again, improved the body's awareness of those muscles, and improved the normal use of the muscles again.
Dr. Duggan will assess you on evaluation and discuss with you if dry needling will be beneficial for you.
For more details please see the link below to read more on our blog.
Why Do I Have to Have a “PT Referral” to Start Treatment?
Alabama is one of the last states in which you must have a referral/prescription for some “Physical Therapy” treatment. Evaluation of your injury can be completed without a referral, but treatment cannot start without one unless you have been seen by a MD, DO, Physician’s Assistant (PA), Nurse Practitioner (NP), Dentist, Podiatrist, or Chiropractor for the same condition within the past 90 days . A new referral for treatment can also come from an MD, DO, Physician’s Assistant (PA), Nurse Practitioner (NP), Dentist, Podiatrist, or Chiropractor licensed anywhere in the United States.
You can bring the referral with you or have him/her fax it to 256-513-9952. If you arrive to the initial appointment without having secured a PT referral, evaluation can be completed but no treatment after the first visit can be performed. The price of the session will remain the same. Below is a referral form that you can take to your provider to have signed. Please contact us if you are having difficulty with getting a referral.
**Wellness services do not require a referral**
This has nothing to do with insurance regulations or reimbursement, and it still applies to our clinic even though were are not in-network with some insurances. If you do plan to use insurance, some insurances require a referral regardless.
If obtaining a PT Referral is proving difficult, please let us know as soon as possible and we can suggest a variety of options for getting one quickly and easily.
You can bring the referral with you or have him/her fax it to 256-513-9952. If you arrive to the initial appointment without having secured a PT referral, evaluation can be completed but no treatment after the first visit can be performed. The price of the session will remain the same. Below is a referral form that you can take to your provider to have signed. Please contact us if you are having difficulty with getting a referral.
**Wellness services do not require a referral**
This has nothing to do with insurance regulations or reimbursement, and it still applies to our clinic even though were are not in-network with some insurances. If you do plan to use insurance, some insurances require a referral regardless.
If obtaining a PT Referral is proving difficult, please let us know as soon as possible and we can suggest a variety of options for getting one quickly and easily.
ProFormance accepts Tricare.
You are contracted with Tri-Care but Non-Network. Why is That Better for Me?
Excerpt from the Insurance and Billing tab
Insurance companies strongly influence the treatment a patient receives at an in-network clinic, which can result in patients not being able to receive beneficial services. We refuse to allow that to be what dictates how you are treated at ProFormance Therapy and Wellness.
We contract with you, the patient. Not the insurance company. You still get many of the same benefits and some times have no price difference!
ProFormance is prefers to operate as a non-network practice because the business model necessary for an in-network practice to survive rarely allows for the high-level care we insist on giving our patients.
What the does that mean?
Currently, TriCare will only pay 70% of their pre-determined allowable rate to a Network provider. To be able to provide the consistent hands-on care during all treatments, focus on constantly progressing and varying your treatments, not rely on modalities to make you feel better, and provide you with additional support outside of the clinic, ProFormance has to stay non-network.
Please see below for a more detailed description of how patients can be better off working with an out-of-network provider.
We contract with you, the patient. Not the insurance company. You still get many of the same benefits and some times have no price difference!
ProFormance is prefers to operate as a non-network practice because the business model necessary for an in-network practice to survive rarely allows for the high-level care we insist on giving our patients.
What the does that mean?
Currently, TriCare will only pay 70% of their pre-determined allowable rate to a Network provider. To be able to provide the consistent hands-on care during all treatments, focus on constantly progressing and varying your treatments, not rely on modalities to make you feel better, and provide you with additional support outside of the clinic, ProFormance has to stay non-network.
Please see below for a more detailed description of how patients can be better off working with an out-of-network provider.
Why is Insurance Not Billed for Some Commercial Insurances, and How Does it Save Me Money?
Excerpt from the Insurance and Billing tab
Insurance companies strongly influence the treatment a patient receives at an in-network clinic, which can result in patients not being able to receive beneficial services. We refuse to allow that to be what dictates how you are treated at ProFormance Therapy and Wellness.
We contract with you, the patient. Not the insurance company, but you can seek reimbursement for our services.
ProFormance is primarily an out-of-network practice because the business model necessary for an in-network practice to survive rarely allows for the high-level care we insist on giving our patients.
What the does that mean?
Due to progressively worsening reimbursement rates and pressure from insurance companies, therapists at in-network clinics have to see at least 2 patients per hour (usually many more), and they often use technicians and assistants to provide much of the actual patient care. The care often includes the majority of a patient’s time at the clinic is spent doing exercises they could do on their own time, heat packs, and ultrasounds. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week.
We do not believe that modalities are typically nearly as effective as our hands-on treatment, and we also do not agree with having patients pay to perform exercises in the clinic that they can easily perform at home or a gym.
All of our patients receive one-on-one care and hands-on treatment from a Doctor of Physical Therapy in every session. With this long-session, one-on-one treatment approach, the plan of care for the vast majority of our patients only involves one appointment per week.
When you consider the time savings of fewer trips to the clinic and the value of resolving your pain so much faster than average, the out-of-pocket expense at ProFormance Therapy and Wellness is a huge bargain.
On top of that, the out-of-pocket expense for our treatment sessions is sometimes less than a patient would pay at a clinic that accepts and bills their insurance.
How is possible to pay less out of network?!
Since deductibles and PT copays have skyrocketed in recent years, many of our patients have high PT copays or have not met their deductible for the year pay less out of pocket for our treatment than they would if they went to a clinic that "takes their insurance".
Be sure you know how much you’ll be paying at your in-network options versus an out-of-network clinic like ours …
These days, some insurance plans provide zero coverage for PT visits or require copays of over $50/visit. And if you have a deductible to meet, you’ll likely end up paying the full bill for your PT sessions until you meet the deductible (and these bills are often $200+ per session). However, you usually won’t start receiving those $200+ bills until after you’ve been getting care for 6-8 weeks and have racked up an enormous total balance after going to PT 2-3 times per week.
Furthermore, just because you’re paying $200+ per session at a clinic that is in-network with your insurance, does not mean that your insurance is applying that full amount towards your deductible! They often only apply the amount that they have agreed is reasonable for your PT sessions which is, of course, far less than the amount the PT clinic actually charges.
Most people are quite unaware of the games insurance companies play in order to pay out as little as possible and maximize their profits. So as you weigh your PT options, it’s very important to:
See the link below for a worksheet to help guide you in working through your benefits.
* One other thing to consider is whether or not you have just one deductible or if you have both an in-network deductible and an out-of-network deductible. If you have two deductibles, then claims from an out-of-network clinic like ours will not apply to your in-network deductible.
With all the above information, you can now get a real sense of what your true costs will be, what level of care you’ll be getting, and then make the best decision on where to receive your physical therapy treatment.
We contract with you, the patient. Not the insurance company, but you can seek reimbursement for our services.
ProFormance is primarily an out-of-network practice because the business model necessary for an in-network practice to survive rarely allows for the high-level care we insist on giving our patients.
What the does that mean?
Due to progressively worsening reimbursement rates and pressure from insurance companies, therapists at in-network clinics have to see at least 2 patients per hour (usually many more), and they often use technicians and assistants to provide much of the actual patient care. The care often includes the majority of a patient’s time at the clinic is spent doing exercises they could do on their own time, heat packs, and ultrasounds. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week.
We do not believe that modalities are typically nearly as effective as our hands-on treatment, and we also do not agree with having patients pay to perform exercises in the clinic that they can easily perform at home or a gym.
All of our patients receive one-on-one care and hands-on treatment from a Doctor of Physical Therapy in every session. With this long-session, one-on-one treatment approach, the plan of care for the vast majority of our patients only involves one appointment per week.
When you consider the time savings of fewer trips to the clinic and the value of resolving your pain so much faster than average, the out-of-pocket expense at ProFormance Therapy and Wellness is a huge bargain.
On top of that, the out-of-pocket expense for our treatment sessions is sometimes less than a patient would pay at a clinic that accepts and bills their insurance.
How is possible to pay less out of network?!
Since deductibles and PT copays have skyrocketed in recent years, many of our patients have high PT copays or have not met their deductible for the year pay less out of pocket for our treatment than they would if they went to a clinic that "takes their insurance".
Be sure you know how much you’ll be paying at your in-network options versus an out-of-network clinic like ours …
These days, some insurance plans provide zero coverage for PT visits or require copays of over $50/visit. And if you have a deductible to meet, you’ll likely end up paying the full bill for your PT sessions until you meet the deductible (and these bills are often $200+ per session). However, you usually won’t start receiving those $200+ bills until after you’ve been getting care for 6-8 weeks and have racked up an enormous total balance after going to PT 2-3 times per week.
Furthermore, just because you’re paying $200+ per session at a clinic that is in-network with your insurance, does not mean that your insurance is applying that full amount towards your deductible! They often only apply the amount that they have agreed is reasonable for your PT sessions which is, of course, far less than the amount the PT clinic actually charges.
Most people are quite unaware of the games insurance companies play in order to pay out as little as possible and maximize their profits. So as you weigh your PT options, it’s very important to:
- Inquire with your insurance company about what percentage of the total PT bill you will be required to pay at an in-network clinic (especially if you still have a deductible to meet). If you will be paying 100% of the bill till you’ve met your deductible, ask the prospective PT clinic the amount of the average bill sent to an insurance company (the PT clinic’s amount on the bill … NOT what the insurance company has agreed they will pay the clinic). In most cases, you will ultimately be paying the full bill until your deductible is met.
- If you have met your deductible, ask how much your copays will be. Ask how many times per week the average patient is asked to come in for treatment.
- Consider the quality of care you’ll be receiving at your various options, and how much value you place on receiving higher-quality, one-on-one care from a Doctor of Physical Therapy rather than a PT Assistant (PTA) or an unskilled “Tech.”
- Consider how often you’ll be missing work and/or time with family to attend your PT sessions. Again, you can ask any prospective clinic how many times per week their average patient is asked to come in for treatment.
See the link below for a worksheet to help guide you in working through your benefits.
* One other thing to consider is whether or not you have just one deductible or if you have both an in-network deductible and an out-of-network deductible. If you have two deductibles, then claims from an out-of-network clinic like ours will not apply to your in-network deductible.
With all the above information, you can now get a real sense of what your true costs will be, what level of care you’ll be getting, and then make the best decision on where to receive your physical therapy treatment.
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Can I Bill My Insurance for Reimbursement of My Out-of-Pocket Expenses?
Excerpt from the Insurance and Billing tab
This depends on the insurance you have, but YES, most NON-Medicare and NON-Tricare patients can send “self-claims” to their insurance company for their treatments at our clinic. You should be able to print claim forms off your insurance company’s website, and send it in with the needed receipts and treatment codes that will be provided upon request at our clinic.
The amount of reimbursement or application towards your deductible is completely dependent on your insurance plan. If you call your insurance company to inquire about what you can expect to receive, you should ask about reimbursement for “out-of-network Physical Therapy” expenses sent in via self-claims. Please download the provided "Insurance Benefits Worksheet" to better understand your financial responsibility.
The amount of reimbursement or application towards your deductible is completely dependent on your insurance plan. If you call your insurance company to inquire about what you can expect to receive, you should ask about reimbursement for “out-of-network Physical Therapy” expenses sent in via self-claims. Please download the provided "Insurance Benefits Worksheet" to better understand your financial responsibility.
What If I Do Not Have a Commercial Insurance?
Excerpt from the Insurance and Billing tab
Some other insurers have made it more difficult for us to provide the care we insist on providing without using insurance. Currently, this includes Medicare. ProFormance accepts TriCare and acts as a Non-Network provider. We accept Medrisk Workman's Compensation patients and are in the process of networking with other Workman's Compensation carriers. Please call and discuss any questions about if this pertains to your insurance.
Medicare Beneficiaries: The US government has some interesting laws that control where Medicare beneficiaries can spend their healthcare dollar and persuade healthcare providers to enroll in their system. You CAN see Dr. Duggan even if you have Medicare even though she does not participate with Medicare. Medicare beneficiaries have the right to enforce their privacy and request that Medicare NOT be billed for any PT services.
*This request to not involve Medicare in payment must be made up front by the patient and be made of the patient’s own free will.
Medicare Beneficiaries: The US government has some interesting laws that control where Medicare beneficiaries can spend their healthcare dollar and persuade healthcare providers to enroll in their system. You CAN see Dr. Duggan even if you have Medicare even though she does not participate with Medicare. Medicare beneficiaries have the right to enforce their privacy and request that Medicare NOT be billed for any PT services.
*This request to not involve Medicare in payment must be made up front by the patient and be made of the patient’s own free will.