Guest guest Posted August 27, 2007 Report Share Posted August 27, 2007 I'm so frustrated! And defeated. I got a letter today that my next to last appeal for more physical therapy has been denied. And the way it is worded, it isn't just for this year, it's for this condition! Get this: " Physical therapy is goal-oriented and is evaluated on the basis of goal achievement, including quantifiable rates of improvement in functional abilities and documented treatment of outcomes at which time physical therapy would no longer be considered medically necessary. The information received does not document this required information. You had reached a plateau with chronic symptoms. Strengthening and passive range of motion exercises can be performed with a home exercise program. Additional physical therapy would be custodial in nature and for maintenance purposes based on the information provided. " Good grief! The whole reason my doctor sent me to PT this time was for pain management! I had quantifiable goals for pain management which my physical therapist documented, and was showing quantifiable improvement in pain levels! I already do strengthening, range-of-motion exercises and a home program. I don't go to PT for those - only for what I can't do at home: traction, massage, ultrasound. I only have one appeal left on this. I don't know that I have any other medical documentation to show them. All I want is to be in less pain so I can have a productive life. I'm not trying to ride dirt bikes, skateboard or sky dive professionally. I have a desk and counseling type of job which is affected by my pain levels. Good grief! Deb Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2007 Report Share Posted August 28, 2007 Sorry Deb, I really hope this works out for you!! Could an attorney help?? Ken.Deb <daveanddeborah@...> wrote: I'm so frustrated! And defeated. I got a letter today that my next tolast appeal for more physical therapy has been denied. And the way itis worded, it isn't just for this year, it's for this condition! Get this: "Physical therapy is goal-oriented and is evaluated on thebasis of goal achievement, including quantifiable rates of improvementin functional abilities and documented treatment of outcomes at whichtime physical therapy would no longer be considered medicallynecessary. The information received does not document this requiredinformation. You had reached a plateau with chronic symptoms.Strengthening and passive range of motion exercises can be performedwith a home exercise program. Additional physical therapy would becustodial in nature and for maintenance purposes based on theinformation provided."Good grief! The whole reason my doctor sent me to PT this time was forpain management! I had quantifiable goals for pain management which myphysical therapist documented, and was showing quantifiableimprovement in pain levels! I already do strengthening,range-of-motion exercises and a home program. I don't go to PT forthose - only for what I can't do at home: traction, massage, ultrasound.I only have one appeal left on this. I don't know that I have anyother medical documentation to show them. All I want is to be in lesspain so I can have a productive life. I'm not trying to ride dirtbikes, skateboard or sky dive professionally. I have a desk andcounseling type of job which is affected by my pain levels. Good grief!Deb oneSearch: Finally, mobile search that gives answers, not web links. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2007 Report Share Posted August 28, 2007 Deb, Would your insurance pay for a TENS unit to do your own electrical stimulation at home? There are also home traction units for the neck and lumbar regions. Maybe they would pay for those as well. My doctor writes me a prescription for massage therapy and I'm able to get a reduced rate with my insurance with certain massage therapists. I'm not sure if your insurance would cover any of this but it would be worth looking into since you need it all long-term. Peggy [ ] Appeal Denied I'm so frustrated! And defeated. I got a letter today that my next tolast appeal for more physical therapy has been denied. And the way itis worded, it isn't just for this year, it's for this condition! Get this: "Physical therapy is goal-oriented and is evaluated on thebasis of goal achievement, including quantifiable rates of improvementin functional abilities and documented treatment of outcomes at whichtime physical therapy would no longer be considered medicallynecessary. The information received does not document this requiredinformation. You had reached a plateau with chronic symptoms.Strengthening and passive range of motion exercises can be performedwith a home exercise program. Additional physical therapy would becustodial in nature and for maintenance purposes based on theinformation provided."Good grief! The whole reason my doctor sent me to PT this time was forpain management! I had quantifiable goals for pain management which myphysical therapist documented, and was showing quantifiableimprovement in pain levels! I already do strengthening,range-of-motion exercises and a home program. I don't go to PT forthose - only for what I can't do at home: traction, massage, ultrasound.I only have one appeal left on this. I don't know that I have anyother medical documentation to show them. All I want is to be in lesspain so I can have a productive life. I'm not trying to ride dirtbikes, skateboard or sky dive professionally. I have a desk andcounseling type of job which is affected by my pain levels. Good grief!Deb Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2007 Report Share Posted August 28, 2007 Thanks for the ideas! I've already looked into some of these options. Massage therapy is only covered when part of physical therapy (which we know is being denied). Electrical stim isn't helpful to me. My PT will give me cut rate on traction, but traction has been helpful only in conjunction with the other modalities. I'm trying to see if it's best to see another doctor before using my last appeal or convince my current ones to write something else, or ??? I hope you're still recovering well! Deb > > Deb, > Would your insurance pay for a TENS unit to do your own electrical stimulation at home? There are also home traction units for the neck and lumbar regions. Maybe they would pay for those as well. My doctor writes me a prescription for massage therapy and I'm able to get a reduced rate with my insurance with certain massage therapists. I'm not sure if your insurance would cover any of this but it would be worth looking into since you need it all long-term. > > Peggy > > > [ ] Appeal Denied > > > I'm so frustrated! And defeated. I got a letter today that my next to > last appeal for more physical therapy has been denied. And the way it > is worded, it isn't just for this year, it's for this condition! > > Get this: " Physical therapy is goal-oriented and is evaluated on the > basis of goal achievement, including quantifiable rates of improvement > in functional abilities and documented treatment of outcomes at which > time physical therapy would no longer be considered medically > necessary. The information received does not document this required > information. You had reached a plateau with chronic symptoms. > Strengthening and passive range of motion exercises can be performed > with a home exercise program. Additional physical therapy would be > custodial in nature and for maintenance purposes based on the > information provided. " > > Good grief! The whole reason my doctor sent me to PT this time was for > pain management! I had quantifiable goals for pain management which my > physical therapist documented, and was showing quantifiable > improvement in pain levels! I already do strengthening, > range-of-motion exercises and a home program. I don't go to PT for > those - only for what I can't do at home: traction, massage, ultrasound. > > I only have one appeal left on this. I don't know that I have any > other medical documentation to show them. All I want is to be in less > pain so I can have a productive life. I'm not trying to ride dirt > bikes, skateboard or sky dive professionally. I have a desk and > counseling type of job which is affected by my pain levels. Good grief! > > Deb > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 22, 2009 Report Share Posted July 22, 2009 Thanks to all... and best wishes Tom In a message dated 7/21/2009 8:59:51 P.M. Mountain Daylight Time, d.cruikshank@... writes: At 09:46 AM 7/21/2009, you wrote: > > >This was just an appeal of the original denial.. I do have a lawyer and >they have already put in the paperwork for time in front of a Judge.. I kn ow >that usually takes a year or so... It took me up until I saw the judge to win my appeal. I started in May 0f 2005 I saw my judge in Feb of 2007 if I remember correctly and got my first payment in July of 2007. Though I understand that PA is one of the longer waits. I wouldn't have won without a lawyer. I was 46 when I was awarded mine, so you should have no problem. I also had education in electronics, computer repair, and Photography. I thought for sure they were going to tell me I had to do phone support or something. Hang in there. Dave **************Dell Deals: Treat yourself to a sweet deal on popular laptops! (http://pr.atwola.com/promoclk/100126575x1223096155x1201715982/aol?redir=http:%2\ F%2Faltfarm.mediaplex.com%2Fad%2Fck%2F12309%2D81939%2D1629%2D6) Quote Link to comment Share on other sites More sharing options...
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