About to enter the PT world

OK, so in my quest to cover all the bases, my pcp wanted me to see one more doc. After seeing yet another rheumatologist who specializes in sports med, having an upper lumbar MRI, I now have a prescription for PT. It turns out I have some minor degeneration in my discs and my neck is a little messed up, too. At least she didn't tell me to stop exercising.
I called the local PT clinic and I have an appointment for next Thursday. When I read the diagnosis to the person on the phone, I said, "and by the way, I am a cyclist. I could use some help with my IT band, groin, and lower back too."
Hopefully this person will be able to help all of my areas.

Hopefully they will be able to help you with all those areas, but if you want your insurance to cover it, get the rheumatologist (or your PCP) to include the relevant diagnoses and a specific prescription. Good luck!

The prescription had several things listed, with something like "alternate modalities as needed" for treatment.
My insurance is really good. They haven't questioned anything since my medical saga began.

Be sure to tell us everything your PT says and does, so we can brutally critique him/her! (jk... sort of! :eek:;))

(too bad you aren't coming to my clinic: we have an injured cyclist program, where we tailor your therapy to you and your bike. You even bring your bike to the clinic so we can see how everything is working!)

Generally we work on all areas that are connected to the issue on the script... and amazingly enough people are made in one complete piece, so rarely do we have to ask for an expanded script! (but we do if there is any chance insurance might cause trouble with reimbursement)

My therapist is a "she." I requested someone that was cognizant of sports medicine, along with the specific problem on the script. Don't worry, I will provide a complete report,
I doubt they will think my insurance won't pay. I have MA Blue Cross PPO, no referrals needed, no questions ever asked once I tell a provider I have them. Since June I have had 3 MRIs, a colonoscopy, an EMG, a bone scan, and countless dr. visits. They did send me a letter wanting me to enroll in a "healthy living" program, which they send whenever you have submitted a lot of major claims. My husband got one after he had an angioplasy and stents put in. He actually called them and said,"I ride my bike 3,000 miles a year, eat healthy, blah, blah, blah." The response was "we can't teach you anything! Wished all people lived a lifestyle like you." Oh, and they paid for my son to have an experimental procedure to cure his Raynaud's (it did).
The only thing they don't cover is acupuncture, which they do cover if you go to a physician who is trained it. However, I chose to see someone else, who adjusted his fee for me.

We have BCBS PPO of California. We had a nightmare with PT for my husband. He had PT earlier in the year, but he didn't get an accurate diagnosis until much later. When he was sent to PT to work on the actual problem, BCBS denied it for too many PT visits in one year. We've gone through all the appeals and they refused to pay. Also, on the second round, they counted every 15 minute increment as one visit! Now we're on the hook for $800 worth of PT.

So, make sure you know how many visits you're entitled to and how to get them *before* you make the visits.

Karen

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Originally Posted by Tuckervill

Also, on the second round, they counted every 15 minute increment as one visit! Now we're on the hook for $800 worth of PT.

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Each 15 minutes is one billable unit. If the PT's office made an error and charged each unit as a complete visit (like an evaluation), they need to correct that.

Alrightly then, I have a question.. Sometimes it takes me longer to do ALL my stretches, so are the billable parts when someone is working directly with me or I'm using specialized equipment (stimulation, getting stretched by the PT, ultrasound) OR total time in the clinic? My insurance statements (Fed BCBS PPO) look like I'm being billed for the direct therapy - so however long it takes to do the exercises doesn't really matter. I'm not facing using up my visit allowance yet, just curious.

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Originally Posted by KnottedYet

Each 15 minutes is one billable unit. If the PT's office made an error and charged each unit as a complete visit (like an evaluation), they need to correct that.

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Oh no, it was BCBS who did it, not the PT clinic. And they refused to fix it! It's a real SNAFU on their part, and we've fought with them as much as we can.

It's a new year, now, though, and our PT place lets him work out on their equipment for $50 a month, so that's what he's doing.

Thanks,
Karen

That's crazy. My son had PT when he was racing and he went a lot, with no problems. I also went to the chiro. a couple of years ago with no questions asked.
We have had a few things they said they wouldn't pay and when my husband called to dispute it they said "OK" and paid it.
I will keep you posted.

Hi Robyn,
I would be interested if you like your PT. I have one in Watertown that I like very much. She is not a cyclist but an athlete and has really helped me. Keep us posted.
Pata

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Originally Posted by bmccasland

Alrightly then, I have a question.. Sometimes it takes me longer to do ALL my stretches, so are the billable parts when someone is working directly with me or I'm using specialized equipment (stimulation, getting stretched by the PT, ultrasound) OR total time in the clinic? My insurance statements (Fed BCBS PPO) look like I'm being billed for the direct therapy - so however long it takes to do the exercises doesn't really matter. I'm not facing using up my visit allowance yet, just curious.

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I'm thinking billable units are only one-on-one time. Modialities (estim, ultrasound, etc) are a flat charge. Our business office does the billing, I just tally what I do with the patient.

I am happy to report that I can't say anything bad about my PT! She used to be a racer and she knows what she's doing. Basically my neck and entire upper left side is imbalanced, tight, and hurting. She spent 20 minutes taking my history and then poked around and asked what hurt. She did a lot of massage, gave me 3-4 exercises to do, and I had a heat/electrical stim. treatment on my neck. She said I'll come once a week for a couple of weeks and then every other week, since I think she realizes I'm motivated to do the stuff at home.
She said I should be doing only easier exercise so I am ready for the season. Well, I'll cut out the yoga and weights, but not the cycling indoors or out. I will tone it down, though.
I went back to work today; the teacher I am replacing had her baby early. Actually, I went in after school to get ready for tomorrow. Thankfully, we have winter break next week, so I can go easy on the kids tomorrow and start for real on the 25th. I don't think I'll be able to do any of the exercises at school, so I guess repeating them 3-5 times at night will have to do. Also, I mentioned that I have some other issues besides what is on the scrip, but I knew she couldn't treat those. She said, not to worry, she can still help as we move through the treatment. The scrip is actually quite general, as I think the doctor knew I've had a lot of stuff for years. In fact, I really think this has been my problem all along and I really don't have fibromyalgia. I will keep you posted.

Hey Robyn- just reading this now, but so glad you seem to be getting to the root of your problems. I meant to ask you about this when we were together, but the time just flew. I had a lot of lingering issues, even 5 years after my cycling accident, that some claimed were nerve damage and would never go away. But, with a really good sports oriented PT, and a custom crank set, everything resolved. The PT I saw did a physical manipulation of my SI joint, which while it was quite painful as she did it, really seemed to do the trick for me. -e

Hira, I do really like my PT; she's a cyclist! I don't know if it would be too far for you; she's at Concord PT, on Baker Av., right off of Rt. 2, before the rotary. She only works 2 nights a week. PM me, if you want more information.

So far, no insurance issues. My scrip was very general, so she has a lot of leeway. She's starting with the neck/shoulder and will work on the IT band later, even if it's just to show me more exercises, since what I'm doing is not working. I am going later today, so will update more then.

I saw a thing on the news about Blue Cross of CA. They were doing some skanky thing, trying to get doctors to "tell" on patients about pre existing conditions. I am glad I live in the nanny state of MA, because we have a lot of laws to protect consumers from stuff like that with insurance. BC stopped sending me letters to join their "healthy living" program, I assume because my # of doctor visits has gone down. I really don't need an insurance company nurse to tell me to exercise!

Yes, I changed my user name. Now it matches my BJ name.
I LOVE my PT.
Yesterday, she did about 10 minutes of massage on my neck. Some was a little painful, but man, when it was done, I felt totally loose and no pain. We talked about cycling the whole time. Then she showed me another exercise for my mid spine to do on the roller, after I told her I had one. Something made me keep my son's after he left home.
Then she checked how I was doing my neck exercises and I got a good grade. Finally, when I mentioned my groin pain/hip flexors she showed me a variation of a stretch that I already knew. She told me I must be climbing right, after I told her this only hurts when I climb or really use a big gear. I already knew this area is usually weak in cyclists, but it's really bad on one side, and very annoying.
Bad thing was, I couldn't get an appointment for next week, since she was booked. I made 3 appointments for the 3 following weeks, though.