10 GHI & Physical Therapy FAQs

10 GHI & Physical Therapy FAQs

08/05/2021

Group Health Incorporated (GHI), now part of the insurance plans offered through EmblemHealth, is one of the largest insurance companies in New York State. If you have a GHI insurance plan, or are considering joining one, you may have questions about how it will affect your physical therapy costs. To help you understand GHI, and its impact on your PT treatment, here are answers to 10 common questions.

What is GHI Insurance?

GHI Insurance was founded in 1937 as the Group Health Association of New York. Over the past 80+ years, GHI has grown into one of the biggest insurance plans in NY state.

insurance-faqs-in-touch (1)In 2006, GHI merged with the Health Insurance Plan (HIP) of Greater New York, becoming EmblemHealth. Today, members can obtain a wide variety of GHI insurance plans through EmblemHealth, including the following:

  • PPO Plans
  • HMO Plans
  • CBP (Comprehensive Benefits) Plans
  • Medicare Plans
  • Dental and Vision Coverage

This array of choices makes it possible for many individuals and families to find the insurance coverage they need with a GHI plan.

Is GHI the same as EmblemHealth?

ghi-emblem-health-logosGHI and EmblemHealth are not the same. EmblemHealth describes itself as a “health and wellness company” that provides insurance plans as well as other health-related services, including primary care, specialty care, and more.

It consists of a family of companies that work together to provide comprehensive healthcare for individuals and families. GHI is one of these EmblemHealth companies, and focuses on providing health insurance solutions for EmblemHealth members.

Other companies within EmblemHealth include HIP, AdvantageCare Physicians, and neighborhood health and wellness programs.

Is GHI a Medicare Plan?

Among the many types of insurance plans GHI provides are supplemental HMO Medicare plans for seniors. This means that their plans provide additional benefits not included under regular Medicare insurance. These benefits can include things such as deductibles, co-pays, and prescription costs. By adopting one of these plans, seniors can enjoy more complete insurance coverage.

Does GHI cover physical therapy costs?

medical-history-ins- (1)GHI does cover physical therapy costs. However, the exact terms and amount of coverage will depend upon your specific GHI plan.

For example, here are some of the factors that may affect your PT coverage under a GHI plan:

  • Whether your plan is HMO or PPO
  • Whether your physical therapist is in-network
  • Your plan’s copays and deductibles
  • Whether you have more visits than allowed under your plan

Because physical therapy coverage varies by plan, you will need to confirm coverage with your insurance provider. However, here at In Touch NYC, we are happy to help you determine your coverage and work with you to obtain the maximum benefits available to you under your GHI plan.

How many physical therapy visits does a GHI insurance plan cover?

Many insurance plans, GHI included, put a cap on the number of PT visits you can have in a year. For most GHI plans, you will be limited to 30 visits per year (PDF). This means that you will need to pay out of pocket once you exceed 30 visits within the year.

What do I do once I meet my PT visit limit through GHI?

Depending upon your needs and tailored treatment plan, you may benefit from more than 30 PT visits a year. In that case, you can submit a benefit extension request (PDF) online at emblemhealth.com. This request, once approved, will entitle you to additional PT visits covered under your GHI insurance plan.

Does GHI insurance require a prescription for PT?

Regardless of your insurance, the state of New York allows you to begin seeing a physical therapist without a doctor’s referral or prescription. This law allows you to save time on waiting for a doctor’s appointment and money spent on that appointment. Under Direct Access, you may see a physical therapist for up to 10 visits or 30 days before needing to see your doctor. Fast, direct access to the care you need can lead to faster relief and better healing.

Does GHI have exceptions to Direct Access?

Members of some insurance companies may still need a prescription or a referral to see a physical therapist, or may need one after their Direct Access visits are up. Currently, most GHI plans DO NOT require a referral from a physician in order for you to pursue physical therapy. [NOTE: May want to double check this with client to make sure I understood correctly]

Do I have to use an in-network provider for my physical therapy?

In all GHI insurance plans, using in-network providers will lead to the greatest coverage and the lowest out of pocket costs. However, you can choose out-of-network providers and still receive some compensation from your GHI insurance plan. You just need to be aware that the reimbursement you receive may not entirely, or even mostly, cover, the cost of your out-of-network visit.

The exact reimbursement you receive, and the extent to which you can see out-of-network providers, depends upon your GHI plan. HMO plans tend to have the least flexibility, while the GHI CBP plan has the most flexibility when it comes to seeing out-of-network providers.

Does In Touch NYC accept GHI plans?

The good news is that yes, In Touch NYC accepts GHI plans. We would be happy to provide you with tailored treatment plans for your physical therapy needs and help you to determine the coverage and benefits you enjoy through your GHI plan.

If you are ready to get started on the path to health, contact us today. We look forward to helping you!

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