About to enter the PT world

[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.

[Crankin]

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.

[Triskeliongirl]

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

[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.

[hirakukibou]

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