FREQUENTLY ASKED QUESTIONS
Is Reid Elam and his family related to Jason Elam, the former kicker for UH and the NFL's Denver Broncos?
Yes. Reid's grandfather is originally from Georgia where Jason's family resides. Reid and Jason are cousins.
Do I have to fill out insurance papers?
One of the advantages of choosing Elam Sports O‘ahu for your Physical Therapy is that we eliminate most of the paperwork that you have to do and we will file insurance claims for you.
Do I need a prescription from my doctor in order to start Physical Therapy?
No. As of December 9, 2010, the State of Hawai‘i became the 46th in the nation to pass into law, Direct Access to Physical Therapy. This means you do not need to visit a doctor to get a prescription for Physical Therapy. Now, if you need Physical Therapy, you just call to schedule an appointment. We will maintain our relationships with many physicians and continue to work hand-in-hand to service our communities and patients to provide quality healthcare. Please keep in mind that most insurance carriers in Hawai‘i still require a physician's prescription for insurance payments. Effective 2016, UHA plans no longer require a prescription for physical therapy services.
Will my insurance cover my therapy?
Each and every insurance plan varies in the amounts and type of medical coverage offered. It is between you and your insurance company to understand your benefits. Prior to receiving rehabilitation services we will verify your benefits however, it is to your advantage to understand your plan and be aware of any limitation. If your insurance company does not cover our services in full, you are responsible for the remaining amount(s) due. If you have any questions, we'd be happy to assist you.
What if I have Medicare?
Effective January 1, 2000 - Medicare Part B will pay 80% of eligible fees after your deductible. The Medicare annual deductible may have been met with another doctor sseen prior to us. You are responsible for your deductible and 20% of the eligible fee. Effective January 1, 2016 - Medicare will not pay for physical therapy and speech language pathology services over $1940.00 in 2016. According to the Medicare legislations, the $1940.00 cap is per beneficiary annual cap. It does not apply per diagnosis or provider. It is vital for you to inform our office of any prior physical therapy visits you may have had in the past or are currently attending. Please note, that Medicare will pay 80% of the $1940.00 cap after the deductible is met. You may qualify to get an exception to the therapy cap limits so that Medicare will continue to pay its share for your therapy services after you reach the therapy cap limits. CROSS-OVER: If you have any insurance in addition to Medicare, your claim may automatically "cross-over" to your secondary insurance which may cover all or part of the 20% co-payment. This service is available if you have notified Medicare of your secondary insurance information.
What if I have HMSA Akamai Advantage, Ohana Medicare, Tricare For Life, Humana Medicare?
Medicare supplement plans vary in benefits from co-payments at time of service all the way to covering 100% of the eligible fee. Because these plans follow Medicare guidelines, the Medicare cap instituted January 1, 2022 may apply.
What if I have HMSA?
If you have Blue Cross Blue Shield (BCBS), there are no visit limits and approval is based on medical necessity. If you have Federal Employee Program (FEP), you are allowed PT/OT/SP services with the following limitations: 75 visits are allowed with the Standard Option or 50 visits with the Basic Option per calendar year. If you have any of the following plans, you are subject to approval from Landmark (EviCore):
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087
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Akamai Advantage
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HMO
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PPO
If you have 087, Akamai Advantage, HMO or PPO, your plan is subject to receipt of authorization from Landmark Healthcare. The prescribed amount of sessions that the physician requests is generally not granted by Landmark. When deciding how many therapy sessions a patient is approved for, Landmark takes previous physical therapy for the same type of illness or injury into consideration. The provider cannot appeal decisions made by Landmark. However, you can. The process for you to appeal is as follows:
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You contact HMSA and tell the rep you want to appeal
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An appeal packet will be mailed to you
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You have to complete all the paperwork and gather supporting documents (Elam Sports O`ahu can help provide documents as applicable)
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You mail the packet back to HMSA
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The appeal will be assigned to a representative and it will be reviewed accordingly
For more information, visit www.hmsa.com and in the search bar, type the word appeal. Or call:
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PPO 948-6111 #5
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HMO 948-6372 #5
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State 948-6499 #1
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Fed 948-6499 #2
A new prescription from the physician asking for more visits, does not result in you being covered by Landmark for more visits. A change in diagnosis does not necessarily produce approval for extra visits.
What if I am on Workers' Compensation or No Fault?
Generally, approved coverage for treatment will be at 100% of the eligible fee. in some cases where litigation is involved, there may be documents that need to be forwarded to Elam Sports O‘ahu by your legal counsel as reimbursement for service that could be deferred. Please check with Elam Sports O‘ahu and your adjustor regarding the latter.
What do I need to know about using No Fault (Auto PIP)?
If you were referred to us under No Fault, this means your motor vehicle insurance company will pay the bills for your injuries up to the personal injury protection benefits (“PIP”) limit. Due to privacy laws, Elam Sports O‘ahu cannot determine how much funds are available, however you as the patient can. It is your responsibility to keep track of your PIP coverage and to notify us when it is close to the limit. After PIP is exhausted, you are responsible for any balance owed. To avoid having to pay for services out-of-pocket, we would be more than happy to attempt collection from your private insurance company(s). Because PIP benefits are paid on a first come, first serve basis, it is extremely important that you verify funds often and notify our staff should you be close to reaching your limit.
What if I am not able to make my appointment?
Because our Physical Therapists dedicate time just for you, please notify our office staff at least 24 hours in advance if you are unable to attend a scheduled therapy session. If unexpected circumstances arise, please contct us as soon as possible to allow us to adjust the schedule. Your cooperation in this matter is sincerely appreciated. A $25 charge will be assessed if 24 hours advance notice of cancellation is not given. Excessive cancellation and no-show appointments may require a discontinuation of service.
How long will I be coming to physical therapy? How often should I come? What if my insurance authorizes less than what was prescribed?
Your Physical Therapist or referring physician will prescribe a frequency and duration for your therapy. It is best to adhere to his or her recommendations but we understand if your busy schedule doesn’t allow it. Try to follow the schedule as closely as prescribed. If you miss an appointment early during the week, we highly encourage you to make up that visit some time during the week…even if your appointments follow on back-to-back days.
How long does each session last?
We ask patients to set aside one hour for each therapy session. Two hours may be required if you are being treated for two separate diagnoses. For a more specific time guideline, consult your Physical Therapist.
What are Elam Sports O‘ahu working hours?
Our clinic is open Monday through Friday from 7:00 am to 7:00 pm and Saturdays from 7:00 am to 5:00 pm. In-Home Physical Therapists at Elam Sports O‘ahu set their own schedules. All treatments are scheduled by appointment only. Please discuss scheduling concerns with your Physical Therapist or the clinic receptionist.
What if I am denied continuing therapy but I still feel like I need more?
Because there is currently a climate of restrictive healthcare policies in place, many of you are not getting the adequate amount of visits you need to realize your rehab goals. Elam Sports O`ahu has a number of programs that allow for a continuum of care. At the end of your prescription, our “Got Your Back” program enables you to continue Physical Therapy on a discounted out-of-pocket basis at an affordable cost. During your prescription period, our “Rehab Warrior” program is another option where you can gain additional visits needed to get you back on the path to recovery. Talk to our patient reps if you are interested in either of these programs.
How long does it take to heal from surgery?
Of course, recovery is dependent on the extent of injury and the type of surgery itself but…we generally adhere to a “3-6-12 Rule” regarding healing phases for surgery. Up to 3 months, you will experience the effects of inflammation (and re-inflammation through rehabilitation) which are the 1st stage of healing – and quite normal. At 6 months you will have forgotten about your surgery ordeal and be quite functional, but complete healing does not occur until 12 months (or longer) when all cellular remodeling is pau!
Why am I still in pain?
Inflammation is the primary cause of pain. Dependent on the site and extent of injury, this could be a “roller coaster” ride initially but will generally subside with time. Management is key to modulating pain. Pain is a barometer of your current condition.
Should I take medication before I come to Physical Therapy?
Opt for pain medications before Physical Therapy if you feel that the medicine will help you get through your session. Do NOT take medication that compromises judgement or your ability to operate a vehicle to come and go from your therapy session.
Do you get x-rays, MRI's or CT scans?
No. If on file, we may request a copy of the report from your doctor, which you as a patient may do at any time.
What is Manual Therapy?
“Hands-on” procedures performed by the Physical Therapist, and includes joint mobilization, soft tissue manipulation (i.e. scar tissue mobilization), manual traction, passive stretching, manually-resisted exercise, segment posturing, and more.
What is the difference between Physical Therapy and Chiropractic?
Basically, Chiropractors (DC’s) link health with the spine and are trained in the art of spinal manipulation. Physical Therapists (PT’s) link health to function and are trained in methodologies to restore function and mobility when impairment and disability limits it.
What should I do to my home to make it safer?
Ask your Physical Therapist. They can make suggestions about additions, deletions or modifications to your home environment.
What is the referral process to obtain Physical Therapy?
The State of Hawai‘i no longer requires a Physician referral to begin Physical Therapy. However, access is ultimately determined by your insurance carrier. You also have a choice as to which Physical Therapy practice you would like to attend, provided your insurance company is participating. At Elam Sports O‘ahu we attempt to make the referral process as simple as possible and therefore require minimal paperwork from you, if any at all! Here’s the referral process, by the numbers:
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Patient and/or Physician decide Physical Therapy is warranted
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Physician writes a prescription for Physical Therapy
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Physician gives the prescription to the patient
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Patient calls Elam Sports O‘ahu Administrative Office at 674-9595 ext 1 asking for Physical Therapy services
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Physician faxes prescription to Elam Sports O‘ahu Administrative Office at 674-9696
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Our New Patient Representative contacts the patient to obtain information to begin Physical Therapy services
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Insurance coverage is verified
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The assigned Physical Therapist or Clinic Receptionist contacts the patient to schedule an Initial Evaluation
…and Physical Therapy begins!
How is my progress communicated to my doctor?
Initial Evaluation: Your first visit with your Physical Therapist is for an Initial Evaluation. Our Administrative TEAM will forward a report to your referring Physician for his/her review.
Progress Notes: Your progress is documented at each visit you have with your Physical Therapist. These notes are also available to your referring Physician.
Reevaluation: Usually, Reevaluations are done prior to an upcoming follow-up visit with your Physician. Your Physical Therapist may print out a copy and ask you to hand-deliver it to your doctor. Otherwise, it will be forwarded to your referring Physician before your visit so he/she will know how things are going.
There are a few insurances, case workers or adjustors who also require some or all of the above listed documentation. Our Administrative TEAM insures that all parties receive the necessary documents.
What will be my treatment progression?
Your Physical Therapy will follow a progression that will allow you to reach your goals to improve your mobility and function, so you can return to a healthy, active lifestyle. We go through four (I - IV) levels of rehabilitation as your body heals and recovers from your surgery/injury.
Level I – Decrease inflammation, pain and swelling.
For example, using ice, elevating the extremity that is swollen, soft tissue mobilization, gentle exercises to make your muscles act as a pump to “pump” the fluid back into circulation and rest.
Level II – Restore pain-free range of motion.
For example, increase your flexibility so that the muscles and other tissues don’t get too tight and cause pain or problems in moving normally.
Level III – Improve muscular strength.
For example, so that you’re injured side is as strong as your other side and as a whole you are as strong, or stronger, than you were before surgery/injury.
Level IV – Reconditioning for a complete return to normal function.
For example, so that you can get back to doing what you like or need to do in a safe and efficient manner.
Level I: Treatment can include procedures such as gentle exercise movements, aqua therapy or modalities like ultrasound, electrical stimulation, microcurrent therapy, low level laser, cold/ice, compression, elevation and splinting/taping.
Level II: Mobility exercises are introduced to maintain any pain-free motion that you currently have, and to begin to improve on that range of motion to limits that are considered within normal or functional limits. Some of the guidelines used are as follows:
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Short arc range and slow movement → pain avoidance.
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Short arc range and fast movement → stimulate nervous system.
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Long arc range and slow movement → strength-stability.
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Long arc range and fast movement → normal function.
Sometimes your Physical Therapist will use manual procedures to assist you in getting back to more normal movement.
Level III: Exercise techniques that allow for tolerable loads or resistance to be used to begin stimulating muscles and the nerves that innervate them. A simple progression within this context is using light loads with small, slow movements and progressing to moderate loads with large, faster movements – kind of like a “super” Level II.
Level IV: This will involve more compound exercises that use multiple joints and large muscular groups. This phase of rehabilitation can also incorporate the use of sports medicine and training techniques to really get you moving.
A lot of activities in Level IV would be more specific to achieve your personal goals – ones that you have set with your Physical Therapist. They also include activities which are designed to improve upon overall fitness.