Checking your insurance
There are so many different insurance plans that it is impossible to keep up with all the options.
It is your responsibility to check your insurance benefits. You are ultimately responsible for
the cost of the therapy provided. Here are some questions to ask you insurance. Please fill in the
answers and bring this with you to therapy.
Insurance Networks
I have the ability to bill most medical insurance including: Medicare, Blue Cross Blue Shield
Wellmark (Iowa) and Blue Cross Blue Shield Illinois, and United. Unfortunately many
commercial plans have preferred networks. It is sometimes challenging to determine if I am in
network or out of network. Here is some information that can help
Medicare - I am in-network for Medicare. Medicare allows a certain amount of money each year
(Jan 1 to Dec 31) for PT visits. If you have used the allotted amount it is very difficult to get
coverage. Please tell Beth if you have had an PT this year so she can call and check.
BCBS - Most plans have out-of-network benefits but there are a few (like Trinity Hospital
Employees) who do not have this benefit and must see an in-network provider. I can help you
find and in-network provider but in some cases there is not a qualified in-network provider.
United - United is a very large company and it is sometimes difficult to get correct information.
If you would like to check my status with United, please have them look in the “group” section
under my business name “Beth Shelly Physical Therapy”. Provide them with my tax ID number
261872863 and have them look with the suffix "00". They no longer qualify individuals and will
tell you the account under my name "Elizabeth Shelly" is closed. Billing will be through the
business and the business is in network. In some cases, patients have been told I am not in
network when, in fact, I am a network provider. Please call me directly if you are unsure.
Aetna or Humana - I am currently not in network for Humana or Aetna as primary insurances.
Sometimes they have covered my services under out of network benefits and sometimes there is
no out of network benefit. Please call your insurance to check.
When checking you insurance
 Insurance often has me listed as Elizabeth Shelly in the individual listing
 If you are searching by office name or group you would look for Beth Shelly Physical
Therapy
 I rent space at Urological Associates on Spring St Davenport only on Monday mornings.
I am only able to see patients from those doctors in that office. If you are seen in IA, I
will bill out of IA for Medicare and BCBS. This may affect coverage for BCBS IA plans
only. Please consider this when checking insurance and when scheduling appointments.
 Tax ID number 261872863
 NPI number 1588624514
 I bill physical therapy as an office visit.
 “Point of Service” (POS) benefits indicate that you have out of network coverage. Please
be sure to determine whether you will be using in or out of network as the coverage is
usually different.
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Please let me know if you have any questions or need more information. Billing is submitted
every week however it takes 4 to 6 weeks for insurance to respond. I have had some patients
with as much as a $70 per visit cop pay - or even worse no coverage at all. This can result in a
very large bill, very quickly. Nobody likes this kind of a surprise. PLEASE CHECK AHEAD
If the therapy will not be covered at Beth Shelly PT you have two choices
1. I can try to help you find another practitioner who can treat your condition. This is very
difficult if you have a pelvic floor muscle dysfunction (leaking, prolapse or vaginal pain).
Unfortunately there are very PTs with this specialized training. Physicians usually send patients
to me because of the depth of my knowledge and skill and years of experience. However, I am
happy to provide referral to other PTs for your condition at your request.
2. Self pay is also an option and can be discussed on an individual basis.
Even though my treatments are specialized, the codes used are not different from regular
physical therapy codes. Here are some common codes.
Common diagnosis codes (this is not an all inclusive list)
728.2 Muscle weakness (this is the most common code used for pelvic floor muscle
weakness often found in urinary and fecal incontinence and organ prolapse)
728.85 Muscle spasm (this the most common code in pain syndromes)
Common treatment codes (this is not an all inclusive list)
97001 PT evaluation
97530 Therapeutic activity
97110 Therapeutic exercise
97112 Neuromuscular re education (the code used for pelvic floor muscle training)
97140 Manual therapy
Please keep in touch. I look forward to working with you.
7/18/14