Frequently Asked
Questions

Pelvic health physical therapy looks specifically at how the function of pelvic muscles, bones, nerves, and immune system interacts with the movement and integration of the whole person. Many people hear about pelvic health physical therapy through friends, media, and sometimes their medical providers. As a direct access provider, Dr. Joanna Hess will be able to add to your understanding if physical therapy would help with your problems... or if not, help you find more appropriate help somewhere else.

Pelvic floor dysfunction is the difficulty coordinating pelvic floor muscles for everyday activities. This may lead to problems with symptoms related to the functions of the genitalia and surrounding organs that include pelvic pain, uncontrolled urination with certain movements and activities, urinary frequency or hesitation, excessive urge for urination or defecation, painful urination, difficulty with bowel movements, bloating, abdominal cramping, pain with pelvic penetration, decreased or unwanted perineal sensations, decreased or painful orgasms, pelvic heaviness, and protruding pelvic organs. The local pelvic floor muscles and nerves are not the only reason why these symptoms might be happening so it's important to look at your health and body holistically. At Hazel Physical Therapy, we coordinate care with your health care team to make sure we get the right answers.

Common medical diagnoses: Stress urinary or fecal incontinence Urinary or fecal urge incontinence Interstital cystitis/Painful bladder syndrome Irritable bowel syndrome Crohn's Disease Dyspareunia Genital arousal disorder Genitourinary syndrome of menopause Endometriosis Fibromyalgia Connective tissue disorders (Ehlers Danlos Syndrome) Chronic Prostatitis Vulvodynia Pelvic organ prolapse: cystocele, uterine prolapse, rectocele, rectal prolapse Urinary: Leakage Frequency Hesitation/retention Pain Bowel: Leakage Constipation Frequency Hemorrhoids, Fissures Bloating Sexual/Penetrative: Pain with penetration Decreased sensation Decreased or unpleasant arousal or orgasms Erectile dysfunction Pain: In perineum, genitalia, groin, abdomen At pelvis, hips, sacroiliac, lumbar or thoracic spine Central sensitization Prenatal/Postpartum/Post-operative: Tissue care after Caesarean delivery, gender affirmation, prostate, endometriosis excision/ablation, pelvic organ removal, colectomy, etc. Deconditioning and weakness Diastasis recti abdominis Return to sport Scar management Concurrent pelvic floor dysfunction Lymphatic drainage

Yes! The body is connected. Endometriosis, spinal dysfunction, GI distress, lower extremity pain and fatigue, diastasis recti abdominis, and postural issues can have strong relationships with pelvic floor dysfunction. At Hazel Physical Therapy, we treat the body as whole to break the cycle of dysfunction.

The assessment and treatments are tailored specifically for your presentation, your history, and your preferences. As a trauma-informed provider, Dr. Joanna Hess prioritizes an environment of safety, transparency, peer support, collaboration, empowerment, and an ongoing engagement of cultural and gender issues. You are always welcome to have someone join your assessment and treatment. For a typical assessment, Dr. Joanna Hess will review your medical history and ask specific questions about your current presentation and hopes for physical therapy. Then, she will look at your body move in normal everyday activities, in parts while comfortably positioned on a treatment table, and if needed evaluating the tone, coordination, and strength of the abdomen, back, and external pelvic muscles. Often, before each part of the exam, Joanna will explain what she is looking for and how it might connect to your problems. For some people, an internal pelvic floor muscle exam helps to identify and begin to give answers to their curious symptoms. An internal exam is always preceded by patient consent and thorough explanation. This exam is never mandatory and can be postponed, because there are many ways to get an idea of how the pelvic floor muscles are function. However, the internal pelvic floor muscle exam, when the patient feels safe, can help improve the diagnosis and treatment process. For the internal pelvic exam, the patient undresses from the waist down and is covered with a gown or sheet. The internal pelvic muscle exam is conducted with a clean gloved single finger to systematically assess the integrity, strength, and coordination of the different pelvic floor muscle layers. Sometimes, the patient can even do their own exam guided by the therapist. After the exam, Dr. Hess will review her significant findings, how this contributes to your presentation, and what you can do about it in the short and long term. For a normal treatment, the time is usually divided between manual therapy, exercises or activities to help your problem, and education on the why and how of to get back to your usual function. Take a look at the specifics on the treatment techniques at Hazel Physical Therapy in the following FAQ section.

The evaluation is usually 50-60 minutes. Follow-up session range from 30-50 minutes. The number of visits depends on your presentation and your availability. At Hazel Physical Therapy, we will make a good faith recommendation for your plan of care with consideration of your time and finances. As a general rule, if your symptoms have been less than 3 months, you can expect to be seen for 2-6 sessions. And if you've had symptoms for longer than 3 months, the plan of care is usually 4-8 sessions. The sessions are often increasingly spaced out as your symptoms and independence with treatment improve.

Sessions can be arranged at your home or at the Studio 34 Wellness Center. As a note regarding accessibility, the Studio 34 Wellness Center is located on the second floor above a steep flight of stairs. If this is an issue, a home visit would be more appropriate. For areas beyond West Philly, a concierge fee of $75 is added and cannot be billed to insurance.

In order to improve your outcomes, communication between sessions is welcomed. Dr. Hess responds by phone or email within 1-2 business days. For any communication requiring more than 15 minutes, you may be invoiced at your next session.

Dr. Joanna Hess has helped many people with complicated and extraordinary presentations. I like to remember that "science doesn't skip you". However, your personal history and story strongly guides your plan of care at Hazel Physical Therapy. This is possible because Dr. Hess has extensive training in many modalities and a strong framework for analysis at tissue, system, and personal level. Joanna acknowledges the disappointment and damage of being strung along for treatment that doesn't work. She prioritizes clear communication and transparency to make sure you get the care you need--at Hazel Physical Therapy or if needed, with another practitioner. If you're hesitant because you've experienced trauma, Dr. Joanna Hess is a trauma-informed care provider. She has helped people from many background receive a higher level of care that redeems previous experiences. Hazel Physical Therapy elevates the concepts of safety, trustworthiness, support, collaboration, empowernent, and engagement of cultural and gender issues for all patients.

Initial assessment are $200. Follow-up visits are $150. For other services, please check the "Services and Prices" page. For some patients, out of network insurance benefits may cover your visits. Please review the FAQ and insurance worksheet to see if you may qualify for reiumbursement. Hazel Physical Therapy prioritizes accessible high quality pelvic health, already reflected in the "under market" rate for specialty and experience. For people experiencing financial instability, sliding scale fees are readily available. While you do not need to submit documentation of your financial circumstances, please review the guidelines for sliding scale levels in the next FAQ so that services can be provided to as many patients as possible. Financial security has many considerations and only you can determine your financial barriers to care.

I have elected to no longer be a preferred provider for insurance companies. Instead, I provide physical therapy on a “fee at time of service” basis as an out-of-network provider. By removing myself from a preferred provider/contracted status with the insurance companies, I do not have to limit the time or quality of treatment I provide because of insurance company restrictions or elevate my rates to pay for billing services. Additionally, I have the flexibility to assist patients in financial need. I accept cash, check or charge card at the time of service. My fees are based on time spent with you and the treatments performed during your appointment. We will provide you with the necessary codes for your claim submission. How to determine your insurance benefits for physical therapy: Call the toll free # for customer service on your insurance card. Select the option that will allow you to speak with a customer service provider, not an automated system. Ask the customer service provider to quote your physical therapy benefits in general. These are frequently termed rehabilitation benefits and can include occupational therapy, speech therapy, and sometimes massage therapy. Make sure the customer service provider understands you are seeing a non-preferred provider/out of network provider who your doctor referred you to. What you need to know: Do you have a deductible? If so, how much is it? How much is already met? What percentage of reimbursement do you have? (60%, 80%, 90%, are all common) Does the rate of reimbursement change because you’re seeing a non-preferred provider? Does your policy require a written prescription from your primary care physician? Will a written prescription from any MD, or a specialist your PCP referred you to be accepted? Does your policy require pre-authorization or a referral on file for outpatient physical therapy services? If yes, do they have one on file? Is there a $ or visit limit per year? Do you require a special form to be filled out to submit a claim? What is the mailing address you should submit claims/ reimbursement forms to? What this information means: A deductible must be satisfied before the insurance company will pay for therapy treatment. Submit all bills to help reach the deductible amount. If you have an office visit co-pay the insurance company will subtract that amount from the percentage they will pay. This will affect the amount of reimbursement you will receive. The reimbursement percentage will be based on your insurance company’s established “reasonable and customary/fair price” for the service codes rendered. This price will not necessarily match the charges billed. Some may be less, some may be more. If your policy requires a prescription from your PCP you must obtain one to send in with the claim. This is usually not difficult to obtain since your PCP sent you to a specialist for help with your condition. If the prescription from a MD or specialist is all you need, make sure to have a copy to include with your claim. Each time you receive an updated prescription you’ll need to include it will the claim. If your policy requires pre-authorization or a referral on file and the insurance company doesn’t have one listed yet, you’ll need to call the referral coordinator at your PCP’s office. Ask them to file a referral for your physical therapy treatment that is dated to cover your first physical therapy visit. Be aware that referrals and pre-authorizations have an expiration date and some set a visit limit. If you are approaching the expiration date or visit limit you’ll need the referral coordinator to submit a request for more treatment. This worksheet is to guide not guarantee reimbursement.

Hazel Physical Therapy values accessible and high quality health care, particularly for people experiencing multiple life stressors like financial instability and persistent health problems. To alleviate some of the barriers to recovery, a sliding scale of 25-50% discount is offered without need for financial documentation. A separate agreement will be generated after communicating with Dr. Joanna Hess. If you have access to out of network benefits, please use this in your consideration for access to physical therapy. Please refer to the insurance worksheet to determine your possible reimbursement. The sliding scale at Hazel Physical Therapy considers (under)privilege, earned assets & debts, current and projected income, and family resources and responsibilities. Please consider paying more if: Your financial instability experience is less than a year and will likely change in a year. Many people experiencing temporary instability have a greater sense of distress even though persistent instability has a larger impact on health and well-being. You live off passive income, work part-time voluntarily, or have a full time job. You have family that supports or can support you as needs arise. My health, race, gender, religion, physical ability, ethnicity, or skin color doesn’t impact my income. I have high earning power (even I'm not earning that much now) or my career is stable and progressing. I can cover my basic needs + some extras regularly. I make more than $57,000 annually. (Philadelphia's median income is $57,537). I have out-of-network insurance benefits or my health care expenses are not a burden. Please consider paying less if: Your financial instability has been ongoing for more than a year and is unlikely to change. You work part-time but would like to work more, or you are not regularly employed. You support your family or have family who is unable or do not support you when needs arise. My health, race, gender, religion, physical ability, ethnicity, or skin color impacts my ability to work / earn money. I am struggling to pay more than minimums on debt or accruing debt for survival needs. I struggle to cover basic needs regularly. I make less than $57,000 annually. (Philadelphia's median income is $57,537). I use COBRA medical insurance, Medicaid or have no medical insurance coverage. Adapted from other Philly practitioners: Nasrene Kordani, Dr. Sonia Williams-Joseph, and Dr. Beth Blum.