PT now is "pay by the minute?"

Something changed in the past 2 weeks. Medicare's regulations re: billing have affected all of us even not on Medicare. I have 2 sessions left (before I've maxed out my PT allotment for the year), so that means I'll become a cash-pay patient. Two weeks ago, the owner had a flat rate for people who were patients and choosing to continue their PT at her facility.

Not so now.

++ To use the gym, the facilities, cables, weights, treadmill, -- I am allotted 22 minutes. That includes my warm up. I cannot come in early to warm up before my appointment. And whatever exercises I do not get done in 22 minutes, I'm charged for another 22 minutes (even if it's 2 minutes over). No stretching, no precision, just processed meat. The price is $39.31 per 22 minute block.

++To do a manual modality, such as Graston deep tissue work, or dry-needling, the cost is $24.30 PER modality and they're allowed to spend a maximum of 20 minutes per modality. (EDIT: Even if one modality takes 8 minutes, and a second modality takes 10 minutes,...I am still charged for TWO separate modalities).

++To get ultrasound (which has been working wonders on creating some new sensations in my otherwise ill-faring limp leg), is $11.10 PER AREA.


To say I'm peeved is to put it lightly, mildly and staying within Forum Guidelines for speech. On the one hand, my (psycho) therapy charges per 50 minute session, so it's not like it's a foreign concept to me.

But on the other hand, this means I must rush myself through my workout, exercises, my PT is limited as to what he can do or for how long and where,--even in related areas.

When I knew my sessions remaining were dwindling down, I started seeing him only once a week instead of twice a week (this past month). And I'll see him next week and the following. But after that, I have got some serious budgeting issues to consider.

I don't spend $$ on shopping, and my biggest investment, to me, is what I have been putting into my life, my health, my body, and my mind.

My insurance company told me there is no appeals process for additional PT. My PMD (saw her recently) said she's strongly encouraging me to try to fight this because in her opinion, this isn't frivolous and I've made far too much progress. My neuro, ortho, PCP and even psych can avail to this.

I'm flabbergasted. My PT spoke to me quietly today after our session and explained that this change had just taken place, and if they do not follow through with this policy with everyone, they will lose their contract with Medicare. (??)

He told me that previously, the owner would charge about $40/session and the PT would just get done whatever he could in a reasonable amount of time. Fine, I told him, that I could do. I even planned this out. I may have even posted about this. That's quite fair.

I work out at a gym as well and thank God I don't have to pay by the minute there, but dear God in Heaven, I feel like a cow with a ring through my nose being led around....Forgive me if I'm being long-winded or too abrupt, but I just got home, I'm worse for the wear, and I am not a happy camper!!

Thank you guys, all of you, for hearing me out and letting me vent! Whew....




M.

So that's what happened to my PT - why they didn't apply for more sessions. I only got 10 total. Maybe aqua isn't allowed anymore?

I think we need to get more organized and talking to our legislators.

Info below says what is needed for an exemption along with other info.

Medicare Limits on Therapy Services-
/www.medicare.gov/Pubs/pdf/10988.pdf

:( It saddens me when someone can't continue with a proven method of medical intervention that works for them because it's cost-prohibitive. I'm sorry about what's going on and fight the good fight!

No appeal process? Hmm, I don't buy it.

Does your PTs office have someone like a patient advocate or something? Or does another doctor you see that coordinates your care? I'm sure you'll have to fight and it may not go anywhere but that's just ridiculous. Your insurance company does not care about your well-being, they only care about their bottom line. I had an issue with coverage for PT once and I have a friend who is an occupational therapist who helped me find someone to write a letter of appeal and the payment was approved for longer than they told me it could be originally.

What I can't understand is why they don't realize that the cost, long-term, of you not having PT covered will be more expensive than than covering the PT you DO have. Ugh, makes me angry.

But if you have someone to advocate for you and make the case for medical necessity of PT then I'm sure there IS something you can at least try and do.

ETA: Good luck, and keep us posted. I'm still green with envy over your exercise capabilities!

We get screwed as it is with pain meds and not being able to get many of them filled.  Then insurance can screw us on co-pays and what meds they will actually cover.  Now its physical therapy? 

How are we to improve the quality of life if it's going to cost us a fortune?  I sometimes reference all this as the "Pain Game" and that's actually what it is, a game.  I'm so tired and want out.  I think that's what they want us to do, get fed up and want out.

So very very sorry this happened to you and I'd feel like cussing as well...

It saddens me that everyday there is another thing taken away from medicare. I can honestly say it won't be around for when I need it and that's just hard to adjust to.

The big problem is all the abuse of the medicare system which is quite too long to posts about on here, but something needs to be done to get medicare up and working better.

Plus too many problems with the system of medicare and it is so very sad.

Again, so very sorry this happened to you and maybe seek out a supplemental plan if you can...

Okay so how odd is this. I called BCBS again, and this time they told me yes there IS an appeals process, where I appeal to the Member Grievance Program. I need to write a letter why I feel it's medically necessary, and I need to include letters from any providers (which will be all of them) stating the same. Then it's reviewed and I'm given an answer within 30-60 days if they'll allow additional PT's or not.

I asked if I would be reimbursed since I'll be paying out of pocket in the meantime, and she said she couldn't say, as that would be another appeals process and it would depend on what "they" have to say.

All of my docs, and my PT, are encouraging me to do this, so I have sufficient backing, but it'll be freaking Groundhog Day 2015 by the time the insurance company gets back to me.

And remember, I am not on Medicare, at all, no affiliation. My PT just informed me that these changes within how the owner must now run her business re: billing in these "charged by the minutes" and stuff, happened within the last 2 weeks because specifically of Medicare. Doesn't matter if anyone is or is not a Medicare patient, we are all affected because of their Medicare contract.

Of course all my doc's offices are closed (because I didn't call early enough in the day) so I'll phone them first thing. Oh, and the docs must send letters to ME and then "I" have to bundle them together with my grievance and appeal and fax it to them or mail it to them in one package. So my docs cannot submit their own reports on me. What the hayyyy?

As I said, I do understand running a business and I get that, I really do. But I also can't help but feel like this carries it too far when it comes to patients paying out of pocket (especially long term patients). I'm never going to be "out" of PT and I know it. With nerve damage healing soooo slooooowly, and having degenerative issues, it's not like I'm going to be doing cartwheels out their door.

I am not on a maintenance program. I am still showing improvement.

And, I'm still peeved. But hey, it is what it is right? Unbelievable.





M.