About to enter the PT world

[Crankin]

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.

[OakLeaf]

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!

[Crankin]

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.

[KnottedYet]

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

(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)

[Crankin]

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.

[Tuckervill]

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