Medcaid reimbursement

[Guest guest]

Any private practice people out there having medicare telling you certain patients coverage will only cover hospital based physical therapy???? I have been getting this the last couple of months and feel this is a restriction of trade. The physicians wont refer to the hospital based therapy and ask me to see them anyway. I agree that we should done some pro-bono but should not be forced into it by the insurance company. I have contacted the APTA and as yet not heard from them and dont feel that a couple of small private clinics and a few doctors will have enough weight to have the state change the statue. Any one have experience with this or suggestions.

[Guest guest]

Dear Sir:

In response to your post requesting assistance with the problem concerning

some insurance only reimbursing for hospital based PT (and not for PT

Independent Practice):

I owned a Private Practice for 13 years (recently sold). I do clearly recall

this specific item coming up. (To the best of my recollection it seems this

was a problem with BCBS of Michigan?)

At the time, we sent information concerning the CPT code definitions as well

as AMA guidelines indicating that there was no difference in services

provided by PT in private practice and in hospital. (You would think this

would be obvious, but quoting third party sources always helps). We also

showed that our charges were considerable less than the local hospital. I

recall that we did eventually get paid for our services. However, I'm sure

we did not effect any wholesale change in their policy. On the other hand,

if enough of us persist...

Is it a restriction of " free trade " ? No question! It certainly is. My

thoughts: to pursue this on the basis of a restriction of free trade would

not be effective. There are so many examples of violations of free trade in

our health care system that the violation of true free trade has become the

rule, rather than the exception. (I'm sure you would agree.)

Why did we finally get paid (despite their policy) ? I would credit it to

the persistence of my staff and arguments based on cost effectiveness.

( " follow the money " ).

I hope this is of assistance.

Your colleague,

Guske PT

Professional Physical Therapy Inc

www.medicalarts4u.com

[Guest guest]

Dear Sir:

In response to your post requesting assistance with the problem concerning

some insurance only reimbursing for hospital based PT (and not for PT

Independent Practice):

I owned a Private Practice for 13 years (recently sold). I do clearly recall

this specific item coming up. (To the best of my recollection it seems this

was a problem with BCBS of Michigan?)

At the time, we sent information concerning the CPT code definitions as well

as AMA guidelines indicating that there was no difference in services

provided by PT in private practice and in hospital. (You would think this

would be obvious, but quoting third party sources always helps). We also

showed that our charges were considerable less than the local hospital. I

recall that we did eventually get paid for our services. However, I'm sure

we did not effect any wholesale change in their policy. On the other hand,

if enough of us persist...

Is it a restriction of " free trade " ? No question! It certainly is. My

thoughts: to pursue this on the basis of a restriction of free trade would

not be effective. There are so many examples of violations of free trade in

our health care system that the violation of true free trade has become the

rule, rather than the exception. (I'm sure you would agree.)

Why did we finally get paid (despite their policy) ? I would credit it to

the persistence of my staff and arguments based on cost effectiveness.

( " follow the money " ).

I hope this is of assistance.

Your colleague,

Guske PT

Professional Physical Therapy Inc

www.medicalarts4u.com