Insurance and referrals
Can I get reimbursed for out-of-network pelvic floor physical therapy in Maryland?
Often, yes. EMS Therapy is in-network with CareFirst BlueCross BlueShield, Aetna and traditional Medicare. For other plans, visits are private pay with a superbill after every visit, which many PPO plans partly reimburse depending on the out-of-network deductible and coinsurance.
The details
What to know
Answered by the practice of Dr. Elana Shalem, DPT, pelvic floor and orthopedic physical therapist.
The superbill lists the diagnosis and treatment codes, the date of service, Dr. Shalem's NPI and Maryland license, and the amount paid. Most plans take it through the member portal; some still want it by mail or fax.
Three questions for the plan before the first visit: Does the plan cover out-of-network physical therapy? How much of the out-of-network deductible has been met this year? After the deductible, what percentage of the allowed amount is reimbursed?
HSA and FSA cards are accepted, and private-pay rates are quoted on the free 15-minute discovery call. Maryland allows physical therapy without a referral.
How it works
How a virtual visit works
Most of pelvic floor physical therapy is education, breathing and pressure management, movement retraining, and a home program. All of it works on camera. During the evaluation, Dr. Shalem guides a self-assessment so she can see how the pelvic floor is coordinating with breath and movement. An internal examination is not possible by video; if a hands-on assessment would change the plan, she says so and helps the patient find local care.
Discovery call
15 minutes, free, by phoneA short call to hear what is going on, explain how visits work, and check insurance or pricing. No pressure to book.
Evaluation
60 minutes, by videoDr. Shalem takes a full history, watches how you move and breathe, and guides the self-assessments she needs to build a plan.
Your plan
Same visitYou leave the evaluation with a plain-language explanation and a short home program, usually a few minutes a day.
Follow-ups
45 minutes, every 1 to 2 weeksProgress checks, program updates, and techniques you can do yourself, for as long as they are useful.
For a video visit you will need
- A phone, tablet, or laptop with a camera
- A private room
- A mat or towel
- About an hour
Questions
Common follow-up questions
What does a private-pay visit cost?
Private-pay rates are quoted on the free 15-minute discovery call so the quote matches the visit type and the plan of care. The evaluation is 60 minutes and follow-ups are 45, one-on-one with Dr. Elana Shalem, DPT.
Can I get reimbursed by my insurance?
Often, yes. Many PPO plans pay part of out-of-network physical therapy. EMS Therapy gives a superbill after every visit to submit to the plan; how much comes back depends on the out-of-network deductible and coinsurance.
Can I use my HSA or FSA?
Yes. Physical therapy is a qualified medical expense, and HSA and FSA cards are accepted.
Do I need a referral to pay privately?
Usually no. State direct-access rules let patients start physical therapy without a referral, with some limits on duration in a few states; the therapist explains any limit at the evaluation.
Is private-pay pelvic floor therapy available by video anywhere in Maryland?
Yes. Dr. Elana Shalem, DPT, is licensed in Maryland and sees patients anywhere in the state by video, usually within a week. The first step is a free 15-minute discovery call.
Your physical therapist
Dr. Elana Shalem, DPT
Doctor of Physical Therapy, University of St. Augustine for Health Sciences, Miami. Licensed in Maryland.
Dr. Shalem treats pelvic health for women and men, from pregnancy and postpartum recovery to bladder, bowel, and pelvic pain conditions and recovery after prostate or pelvic surgery, and general orthopedic conditions of the back, neck, hips, knees, shoulders, and feet. Visits are one-on-one and unhurried, and she explains what she is seeing in plain language.
More about Dr. ShalemPrefer to write? Send a message.
Questions about insurance, pricing, or whether physical therapy is the right next step? We reply within one business day.
Start with a free 15-minute call.
Tell us what is going on, hear how Dr. Shalem would approach it, and decide from there.