SAHP Therapies

How many visit limits does Physical Therapy have?

• None, but visits will take away from other therapies such as chiro & acupuncture.

• 12 visits per calendar year

• 12 visits per calendar quarter

• 8 visits per calendar year

In network PT visits are covered how?

select option(s) below:

• 1 re-exam allowed, but patient must show significant change in the patients condition to be considered.

• Initial + re-exam are covered per TAX ID.

• Initial exam $25 copay, then 90% after the $500 hosp/med ded has been met

• There are no visit limitations, however, visits will take away from the limitations for other therapies such as chiro and acupuncture.

What is the visit limitation for CHIROPRACTIC?

• 12 visits per calendar year-visits are combined with other therapies such as PT and acupuncture.

• 12 visits per calendar quarter-visits are combined with other therapies such as PT and acupuncture.

• 8 visits per calendar year - visits are combined with other therapies such as PT and acupuncture.

• 8 visits per calendar quarter - visits are combined with other therapies such as PT and acupuncture.

What is the max plan allowance for a CHIROPRACTIC visit?

• $25 max allowance

• $55 max allowance

• $65 max allowance

• $45 max allowance

What is the visit limitation for ACUPUNCTURE?

• 12 per calendar year.

• 12 per calendar quarter.

• 8 per calendar quarter.

• 8 per calendar year.

An acupuncturist orders X-Ray of the spine, how is this covered?

• X-rays of the spine ONLY when medically necessary. 

• Tests, equipment and/or supplies must be ordered or provided by an MD.

• Tests, equipment, & supplies are not covered under the Plan when performed or ordered by a certified acupuncturist.

• Tests, equipment, & supplies are only covered under the Plan when performed or ordered by a certified acupuncturist.

If River Phoenix went to the chiropractor 8 times between the dates of 10/3/2023-11/7/2023 how many acupuncture visits does he have left in the year?

• 4 visits left.

• 0 visits left.

• Chiro has no limit.

• Acupuncture has no limit.

When quoting an IN NETWORK THERAPIES benefit, what all do you need to include in order to have a COMPLETE BENEFIT QUOTE?

• Initial exam cost of $25, does not apply towards ded. $500 hospital/medical deductible, then covered at 90% coins

• Visit limit max is per calendar quarter.

• If any plan max pay allowance per visit applies.

• Visit limit max & applies towards what other visits

Does place of service matter when quoting the initial visit copay?

select the correct answer(s)

• If the patient is having PT done as outpatient hospital the copay is $65. Quote hospital benefits.

• If the patient is having PT done as outpatient hospital the copay would be $65. Quote hospital benefits.

• If the patient is having PT done as outpatient hospital there would be no co-pay. Quote hospital benefits.

• If the hospital is out of network, there is no coverage.

When quoting OON Speech/Vision benefits, what is 1 very important thing to remember?

• The patient will owe anything that exceeds what the Plan allows up to the OON provider’s charges but no more than $65 per visit

• The patient will owe anything that exceeds what the Plan allows ($65) up to the OON provider’s charges.  

• The patient will owe anything that exceeds what the Plan allows ($55) up to the OON provider’s charges.  

• The patient will owe anything that exceeds what the Plan allows up to the OON provider’s charges but no more than $55 per visit