About to enter the PT world

[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

[KnottedYet]

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.

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.

[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.

[KnottedYet]

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.

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.

[Tuckervill]

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.

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

[Crankin]

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.