Physical THerapy-CareOregon

[Guest guest]

I'm trying to find out how to get my insurance to pay for physical therapy for a

leg problem I have. I have CareOregon, which is the local medicaid and they are

really hard to get to pay for physical therapy other than for post surgical

stuff.

Well, I'm trying to prevent surgery. They say they will pay in some instances. I

did talk to them. But they won't tell me what and my doctor refuses to play

guessing games.

I have what's called trendelenburg leg, which mean an instability in my hip

muscles. But IO have so many other back problems it seems I will fit in many

categories if I just knew what they were.

Anyone with this insurance who has been successful with them?

Carolyn Eddy

" Sweet Goat Mama "

[Guest guest]

Carolyn wrote:

> I'm trying to find out how to get my insurance to pay for physical therapy for

a leg problem I have. I have CareOregon, which is the local medicaid and they

are really hard to get to pay for physical therapy other than for post surgical

stuff.

>

> Well, I'm trying to prevent surgery. They say they will pay in some instances.

I did talk to them. But they won't tell me what and my doctor refuses to play

guessing games.

>

> I have what's called trendelenburg leg, which mean an instability in my hip

muscles. But IO have so many other back problems it seems I will fit in many

categories if I just knew what they were.

>

> Anyone with this insurance who has been successful with them?

>

> Carolyn Eddy

> " Sweet Goat Mama "

Carolyn,

I don't have Oregon but with my Medicare, they need a letter of justification

from my doctor and then they paid.Seems you could look up the justification or

cases online of what they allow and disallow in the handbook.

Then you could have you Doctor write the letter of justification for you. I

would call a case manager with CareOregon.

Carolyn, I went to CareOregan, typed in physical therapy, and up popped forms

for the providers and for physical therapy it has the requirements the physician

has to put to be approved . There is a toolbar marked providers and members and

you have to click on the providers to see the requirements.

Some of what it says is:

The treatment of a physical disability, either correcting or alleviating the

disability by the use of therapeutic exercise and other interventions that focus

on improving posture, locomotion, strength, endurance, balance, coordination,

joint mobility, flexibility, activities of daily living, and alleviating pain.

Treatment may include active and passive modalities using techniques based on

biomedical and neurophysiologic principles (e.g., hydrotherapy, electrotherapy,

application of heat and cold).

The link address is :

http://www.careoregon.org/Providers/ProviderFormsandPolicies.aspx. I just

happened to come across this and our Tricare is sometimes like this, its as if

you have to type in what the handbook says to get it approved. Good Luck and

let us know what happens. Bennie