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by David Merson, DPT, ATC

If you’re like most patients, choosing a health care provider, scheduling appointments, and dealing with your health insurance company may be a daunting and confusing process.  Keep in mind these few helpful steps as you plan your path to recovery.

Step 1 – Choosing an Insurance Plan

Choosing the right health insurance plan can be a very intimidating task.  Patients often make the error of choosing the least expensive option, which typically comes with the least amount of coverage, and ultimately results in the highest out-of-pocket cost per visit to the patient. When choosing a plan, be sure to review not only if your care is covered, but also what the terms of coverage are (e.g. how frequently you are allowed to receive treatment; if there is a limit to care per diagnosis, per benefit year, or per lifetime; whether the plan limits your choice of providers).  Be aware of any costs that might be assigned by your plan as your patient responsibility, such as a deductible, co-insurance or co-payment. This will help you better plan for the out-of-pocket cost of your care. If you would prefer not to go through your insurance due to high cost, many providers, including Boston Sports Medicine, offer competitive self-payment options. Always be sure to inquire about self-payment rates with each individual practice or provider prior to the start of your care.

Step 2 – Choosing your Sports Medicine Team

There are many healthcare providers that fall under the realm of sports medicine, among them primary care physicians, orthopedic physicians, physical therapists, and athletic trainers.  The primary care physician is typically the first provider to be consulted about an injury. He or she may then refer the patient to a specialty provider such as an orthopedic physician or a physical therapist. Physical therapists specializing in sports medicine and orthopedic rehabilitation primarily deliver care in a private practice setting or in a hospital-based outpatient department.   Certified athletic trainers, provide sports medicine services in a high school or collegiate setting, or as part of an orthopedic physician’s office staff.

Step 3 – Your First Appointment

When attending your first appointment with a new provider, please be sure to bring along all of your injury-documents, which may include a prescription from your physician, imaging reports, and your health insurance card (or claim information in the case of worker’s compensation or motor-vehicle injury). Try to be there a few minutes early in order to leave time to complete the intake paperwork. Check if the provider’s new patient forms are available on their website, in which case they can be completed beforehand to save time during the appointment.

Step 4 – Knowing the basics of your health coverage

Always review your benefits with your health insurance for any specialty services prior to your first appointment. Most insurance companies have this information available online. Patients insured by an HMO-based plan typically require a referral from their Primary Care Physician in order to see a specialist.  Those with a PPO-based plan usually do not require a referral, but may have other strict requirements, such as a notification within 24 hours prior to the first appointment. Failing to follow your individual plan’s guidelines may adversely affect your benefit coverage; therefore always be sure to know before you go.

Dr. Merson is a Physical Therapist at Boston Sports Medicine