@babs10 I really don’t know anymore than what I’ve posted. My primary referred me to the program. She said that it was new, she had just found out about it, and it was covered by insurance. When I called to make an appointment, I asked if it would be covered, and was told it is covered by Medicare, leaving a very small amount not covered. (Under $10). Before I had my initial evaluation, I had to submit a copy of my latest bone density, and a prescription from my doctor. These are required as per the ONERO website. When I read that other PTs had trouble being paid, or flat out saying that Medicare does not cover it, I again questioned about coverage, and was told it is covered. I do know it is billed as ONERO, not physical therapy at $60 and change.
It seems that some PTs are charging out of pocket without having asked for the Rx or report upfront. If they truly are certified to be an ONERO provider through ONERO, they should know the procedure and correct code to bill Medicare. I only had my evaluation early January, and since it is the new year and these are my first Medicare claims, I have to pay the first $283 before the Medicare coverage picks up. When I received the statement from my secondary, I saw that they paid everything but the $25 copay. As soon as I hit that $283, Medicare will cover all but $6 and change. I really don’t know why other PTs are having such difficulty. It could be that they aren’t ONERO CERTIFIED, or it’s how/how much they are billing. If they are certified they have to call Medicare and figure out what they are doing wrong.
I love the program. It’s small group, 4-6, and everyone is just the best! I really do hope that you all can find a certified provider. In the 6 or 7 weeks that I’ve been doing this, 2x/wk, I feel a difference. Wishing everyone the best!