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Thread: physical therapy limits set by insurance companies

  1. #1
    Join Date
    Oct 2003
    Location
    northen calif
    Posts
    4

    Question physical therapy limits set by insurance companies

    Hi, I'm looking for info on how best to utilize my ins. coverage for both pre-op conditioning and post-op therapy. I have Blue Cross EPO and Medicare A&B secondary coverages. Does anyone know if I can use more than the stated 12 visits per year? That hardly seems enough for post-op therapy much less pre-op conditioning.I have also developed bursitis due to the lack of using my shoulders in full ranges of motion because of the sedintary lifestyle my scoliosis has created. Would insurance consider that a different condition and allow 12 visits for that also? I'm currently facing a T12 to S1 fusion. Any thoughts would be greatly appreciated!
    Kindest Regards,
    Des

  2. #2
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,793
    Hi Des...

    I know very little about insurance, so can't help you there. However, most people that I've come across do not do any post-op physical therapy. We get occupational therapy in the hospital to help us walk, climb stairs, etc., but no real PT. The only patients around here who get PT post-op are those that have some sort of minor complication. And, I don't think that the OT/PT done in the hospital actually counts as a PT visit in terms of insurance.

    Also, with a good physical therapist, they should be working with you to train you to do exercises on your own. The trick is to find a good PT.

    Regards,
    Linda

    P.S. I sent you a private message (pm) yesterday. Did you receive it?

  3. #3
    Join Date
    May 2004
    Posts
    35

    PT/OT in the hospital

    I've been an occupational therapist for 18 years and one thing I can tell you is that, in health care, good things often come to those with the BIGGEST MOUTH! Wrong as it may seem, that's very often the case. In a perfect world, anyone who could potentially benefit from rehab post-op would get it. But in our current environment of costly services and rejected insurance claims, the bare minimum is often what is provided. (In my own defense, I must add that its not the fault of the individual providers, we're strapped for time and doing all we can!) My advice is ASK, ASK and ask again. In my job, I will make time first for a patient who is inquiring and motivated (and a squeaky wheel). I think anyone of us who works in human services would agree.

    I have a relative who is hospitalized now for an aneurysm. He is 93 and has been bed-bound for several weeks. Of course he needs to have PT so his muscles don't atrophy and get stiff. He did not get it until I encouraged my mother-in-law to ask. He now gets a brief PT session daily.

    If you think you'd like a few sessions of homecare or outpatient rehab to perfect an independent exercise program, say so. Don't be afraid to state what you think you need. Then tell your therapist what YOUR goals are.
    Nora

  4. #4
    Join Date
    Jul 2004
    Location
    Virginia
    Posts
    6
    After my surgeries in 2002 I demanded PT and OT. My insurance had set limits too. The way I got around that was to have my orthopaedic dr write a letter to the insurance company stating that it was medically necessary to have the PT visits to strengthen my back muscles. Thus in turn would prevent further surgeries they would have to pay for. Once I began PT the insurance company just requested to have progress reports but had no problem preauthorizing the visits once the letter was submitted.
    Alison
    Upper 98
    Lower 96
    3 surgeries Jan 02' Mar 02 & Sept 03'

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