Rehabilitation

Every insurance plan has its own rules. Some insurance carriers have different levels of coverage within the overall company, and their rules may vary widely. For example, Blue Cross has HMO Blue, Blue Cross PPO, Blue Cross Out of State, Empire Blue, Medex and Blue Care 65. Each has its own set of rules.

In order to be sure what your coverage is and responsibility is, you must call your insurance company (the phone number will be listed on your insurance card) and ask your benefits team about your coverage and responsibility. Knowing what to ask is key.

Coverage Details

You will want to know the following:

• Do I have a co-pay? If I do, how much is it for this service? 
• Do I have a deductible? If yes, what is the amount? Have I met it? 
• Is there a co-insurance? 
• How many visits am I allowed within a specified time? 
• When does my benefit year begin and end? 
• Do my visits require an authorization and if so, how do I obtain one? 
• Does the authorization have to be in place before I begin my service? 
• If I began treatment without an authorization in place will the insurance allow backdating to cover it? 
• Who is my primary care provider (PCP)? 
• If I have been treated for this condition before, will insurance cover new visits? 
• Is MetroWest Medical Center (MWMC) in network or out of network? What tier? 
• Is therapy considered a “specialist”? (If so, the co-pay may be higher than an office visit)

Should your insurance carrier ask, the MetroWest Medical Center Rehab Services NPI# is 1740252592.

Inpatient rehabilitation generally refers to doctor and therapy services you receive during a stay in the hospital. 

Outpatient rehabilitation refers to services you receive when you’re not admitted to the hospital, such as doctor services and physical, occupational and speech therapy.

Physical, occupational and speech therapists treat many conditions and injuries on an outpatient basis, including: 

• arthritis 
• neck, back and shoulder pain 
• facial and jaw pain 
• balance disorders 
• vertigo
• hand injuries 
• carpal tunnel syndrome 
• knee and leg injuries or pain 
• lymphedema 
• neurology disorders 
• speech disorders 
• swallowing disorders 
• sports-related injuries 
• work-related injuries

On your first visit, if you could arrive 15–20 minutes before your scheduled appointment to fill out your paperwork. During your evaluation, you and your therapist will discuss your needs for therapy. At this time, your therapist may also use some tests (e.g., to measure your strength, range of motion, pain) to establish appropriate goals with you.

Your treatment may consist of a variety of modalities, manual therapy, stretching and strengthening exercises, injury management and prevention education.

You should wear something comfortable, and it should allow the evaluating therapist to access the body part that will be receiving treatment. We also have gowns available for patient use.

Your insurance plan will determine your co-pay. Any questions about what your particular insurance covers should be directed to your insurance company. Copays are due at the time of your treatment and please check with your insurance company to understand the specifics of your plan.

Usually treatment is most effective if you come 2-3 times a week, but we will work with you to meet your specific needs for the best possible outcome. The time and length will be determined between you and your therapist, depending on your need.

Evaluations and treatments are approximately 40 minutes.

You’ll need a recent prescription from doctor's office, preferably dated within the past 2-3 months, your insurance card, a referral from your primary care doctor (as needed for your insurance company), a list of your current medications and a photo ID.