Onero exercise and Medicare

@cobb @molly4619 I wonder if the certified Onero PTs are reluctant to go through insurance? I'm definitely interested in seeing how this plays out. Please keep us posted!

@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!

@molly4619 That is super helpful Molly!

The ONERO certified place nearest to me does not have a Physical Therapist, but they have 2 Physical Therapist Assistants (PTAs) who are ONERO certified. I see no evidence of a full PT there, so maybe that is why they did not mention insurance. I am sure that PTAs are plenty qualified to implement their ONERO certifications.

I have not started, even with possible self-pay, myself there because they wanted a 1-year commitment. This studio is 35-55 mins each way for me and the program is 2x per week. I offered an initial 1-month commitment but that was not acceptable to them for various reasons, including that they like to build a cohesive group for the sessions.

I have instead gotten some training elsewhere in the LIFTMOR moves. Deadlifts, back squats, and overhead press (hardest for me) are standard weight lifting moves, but they must be done in correct form. The impact 4th component of LIFTMOR does not seem as good as drop jumps based on other literature that I have read. So for impact I do 50 drop jumps from about 10 inches instead of the jumping pull-ups.

If an ONERO program comes up closer to me then I plan to sign up even if self-pay. My doctor seems quite progressive so I may be able to get a prescription from her and get part paid by insurance based on your experience.

My doctor wrote a script for bone program at local physical therapy place and they accepted it. Been 4 months now. I hope it can continue longer.

@debraran Is it Onero or something different? Good for you for getting coverage!

@babs10 I live in the states and it follows closely the "Liftmor" program. It's at a rehab facility. From what I hear a hospital is starting to do it also. I don't think they use the name in advertising but call it a bone program. We do the 4 exercises they have and my therapist adds core exercises, leg etc to round out the 45 minutes.

I work in a private mental health (social workers and psychologists) practice. Here is what I know about Medicare.

Most often PT services must be prescribed by a physician.

Then the physical therapist (or in our case mental health provider) must have the required credentials for Medicare to approve payment for services. In our practice we are all Medicare-approved (licensed Ph.D. in psychology, MSW in social work). That is the first step. This first approval process can take one or more months. Then, the billing process is far more complicated than billing through private insurance such as BCBS or Aetna. The reimbursement that we finally receive is about 30% less than what we collect from private insurance.

I suspect that some of the PTs that you've encountered do not take Medicare for the reasons I stated above. In addition, a PTA (PT assistant) cannot qualify for Medicare unless they work under the direction of a fully qualified provider such as a PT.

Confused? Yes, it's a perplexing process but this is how it works across the U.S.

@debraran Onero is the evidence-based, clinical exercise program developed from the LIFTMOR study. Onero is the commercial program that implements the LIFTMOR protocol under supervision. It's wonderful to hear that these programs are appearing more and more.

@naturegirl5
The physical therapist I see is credentialed for medicare. They don't use PTA's at this facility, just aides to help with exercises but my therapist doesn't have one.
I did need a referral for bone health program from my doctor.

@babs10 Yes, my therapist told me today, he's had so many patients since me. Before that it was 3. I wonder if my doctor before she left passed on the program to others but also my PCP asked about it. A large hospital is also implementing a program that will need a referral but exciting to be able to reach others not in my area of the state.