posted
I've been seeing this PT for a while. My insurance pays 25 visits which her office called to verify with my insurance company.
She kept telling me we'd start stabalization excercises which over a long period of time will dramatically help the neck/back pain, cocyx pain due to a fall years ago.
I had an appt. Thursday at 3:30, Her receptionist calls Thursday at 1:30, tells me I've used 25 visits and my options are to wait until this therapist starts her pilates class in September or pay cash.
I felt this office handled this very unprofessionaly. Why was her office not on top of the number of visits I'd had? To call 2 hours before my appointment, cancel me then basically dump me when she didn't do her job by showing me these exercises.
I asked the receptionist to have this lady call me which she didn't return my call.
What would be the best approach since she feels the need to blow me off?
Posts: 911 | Registered: Mar 2005
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posted
Most providers don't track or cant keep track of sessions. I would not hold this against them.
In some cases you could call your ins company and see if you could get more sessions authorized--- or see if your PCP or LLMD might be able to make a referral under different circumstances.
-------------------- Positive 10 bands WB IGG & IGM + Babesia + Bartonolla and NOW RMSF 3/5/09 all at Quest
posted
Usually, the PT person can put in a "request" for more sessions. If the PT person states certain things that meet their criteria (basically that you were stabilizing and improving in therapy), insurance sometimes will extend coverage.
I've had many expieriences with PT offices. One PT dropped me after only 4 Sessions (My Ins. covers 60 sesions). She dropped me because she said that I had "Not improved quickly enough". ?? I was confused.
The next PT place was very kind, once I reached 60 sessions they submitted a letter to my ins. company saying how well I was doing and how I'd gained the ability to walk with a walker, and sometimes even crutches, etc. The insurance company put in an approval for 20 more sessions & said that if improvement increased all the PT had to do was re-submit this form and I could get more sessions (20 more) each time. I've continued to do this for 3 years now, 20 sessions each time we re-submit.
I hope it works out for you!
Posts: 371 | From CT | Registered: Jun 2008
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posted
As a therapist myself, I think it was very unprofessional of your PT to suggest you attend her Pilates. You should speak to her, tell her you feel in 25 sessions she failed to give you back stabilization exercises, which she indicated would be helpful.
I have called insurance companies many time to extend my patients treatments.
Are you any better from PT?
Posts: 561 | From eastcoast | Registered: Aug 2006
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Geneal
Frequent Contributor (5K+ posts)
Member # 10375
posted
As a ST, I always kept track of how many sessions I had authorization for.
Generally was unable to request additional therapy time until said visits were used up.
However, knowing that this request could be as easily denied as granted,
I always set my patients up on a home program.
Always.
You need to show continued improvement with regards to additional visits being granted.
If for some reason your PT documented that you had "plateaued",
Then the authorization for additional therapy will probably be denied.
I would do the following:
Call for PT again today. Say it is imperative you speak with him/her.
Send a letter to their office manager stating the situation and the poor handling of it.
CC a copy to the PT.
Request a copy of all progress notes and evaluations the PT has completed on you.
Call your insurance company and ask if additional therapy sessions were requested.
(I would do this after getting copies of all notes/evals if progress is continually documented).
Agree that this is less than professional.
Cash......what is that?
Pilates class? I've got an 8 x 10 of me doing that without any stabilization therapy.
Hang in there.
Hugs,
Geneal
Posts: 6250 | From Louisiana | Registered: Oct 2006
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posted
I left another message with this PT. Her receptionist said she got your message but has been to busy to call you. Sounds like bunk to me. She did indicate that today was a lighter day, and she'd be calling me. Again, Have yet to receive a phone call.
Tomorrow I'm requesting all notes etc. to see where things are at. What I find interesting is when I called my insurance company to find out about additional visits, they told me there's an authorization line that this office needs to call. Again, the ball dropped.
I feel I'll be blown off because this therapist has 60% ownership in this clinic. Of course I'll be sending a letter..doubt it will help.
Posts: 911 | Registered: Mar 2005
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