Re: Physical Therapy Insurance Question

[Guest guest]

Dear all,

I hope you are doing well and that 2008 has kicked off with a good

start for all. I have a question (and this is because I'm largely

ignorant about how insurance works in the U.S.). I just received a

frightening letter from my insurance company saying that the last few

physical therapy sessions I've been to may not be covered. Apparently,

even though I'm allowed as many sessions as " medically necessary, " for

my insurance, medically necessary means about 20 sessions. Physical

Therapy has gotten me to the point where I'm 99% pain free, and I know

that when I stopped, I had a few flare ups. The thought of having to

stop therapy is very scary. THe representative for my insurance

company said that insurance doesn't cover " maintenance therapy. " BUt I

guess I'm just confused because in conditions of chronic pain, I feel

that maintenance therapy IS medically necessary. Does anyone know how

I should navigate this? Thank you all and especially Dusty for

continued support and advice. I will call my physical therapist, as

I'm sure she can help me put together a convincing case, but just

wanted to vent about how utterly evil these insurance companies are. .

..

Mara

Mara Fortes

(USA)

011-52-55-55-54-22-95 (Mexico City)

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[Guest guest]

Mara,

Every company is different, so talking to your PT is probably the way

to go. I pay for PT but then submit claims and get reimbursed. My

insurance company trusts my PT when she says that I need the continued

therapy.

Melinda

[Guest guest]

Hi Mara--I don't have specific advice on how to deal with your insurance company in this particular situation. My old insurance company initially refused to cover ANY amount of PT for this condition, but I fought them through appeals and eventually through the land Insurance Administration. (Every state I think has an Insurance Administration). And ultimately I won, though it did take nearly a year and I had to fight them for every last penny. Then I thankfully moved and got a new job so I have different insurance now. So I would suggest appealing, then if that's not successful, contact your state's Insurance Administration.What kind of PT was it that has helped you? How long were you going before you noticed a big difference? Did you have a home PT program as well?Thanks, and good luck!

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[Guest guest]

Dear Jul,

Thank you for the advice! I'm now relying on my therapist to make a

convincing case for my insurance about why my sessions were " medically

necessary. " So I guess I'll have to wait and see what happens. I had

chronic unrelenting pain for over a year, and I wen through a myriad of

treatments and diagnoses (including anti-seizure medications,

anti-depressants, cortisone ointments, etc). Finally, I decided to

stop everything and just focus on living stress free, eating well,

doing lots of yoga and exercise, and I managed to get my pain to

intermitent. I started physical therapy about year ago, and went to it

maybe 20 times, and from the first couple of times I noticed a

difference. I was doing pelvic floor muscle therapy (and a little bio

feedback). I honestly don't know what causes my pain/flare ups, but I

kinow that because I get inflamed, my muscles down there do not act

correctly. SO PT has helmed immensely in retraining my muscles to

relax. I am pain free about 99% of the time. Usually, I have some

symptoms around my period. I don't have a problem with yeast, and I

think my vulvodynia was largely caused by being overmedicated to treat

yeast infections, antibiotics ,etc.

hope this helps. you can email me individually if you want to talk in

more detail.

best,

mara

--- Jul Marie wrote:

> Hi Mara--

>

> I don't have specific advice on how to deal with your insurance

> company in this particular situation. My old insurance company

> initially refused to cover ANY amount of PT for this condition, but I

> fought them through appeals and eventually through the land

> Insurance Administration. (Every state I think has an Insurance

> Administration). And ultimately I won, though it did take nearly a

> year and I had to fight them for every last penny. Then I thankfully

> moved and got a new job so I have different insurance now. So I would

> suggest appealing, then if that's not successful, contact your

> state's Insurance Administration.

>

> What kind of PT was it that has helped you? How long were you going

> before you noticed a big difference? Did you have a home PT program

> as well?

>

> Thanks, and good luck!

>

>

>

>

>

>

> ---------------------------------

> Looking for last minute shopping deals? Find them fast with Yahoo!

Search.

Mara Fortes

(USA)

011-52-55-55-54-22-95 (Mexico City)

________________________________________________________________________________\

____

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