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I have hit my limit for PT that my insurance will cover, now what

I had my 20th and final PT that my insurance will pay for. In order to have anymore, I will have to have an appeal for the insurance approval. Has anyone else dealt with this? Im sure others here have had long term PT also. My PT and I had talked about it and we are going to give some time to find out if I need to continue. I can not afford to pay for it outright. Does anyone have any ideas of other ways to get through without PT? I cant have injections because of an allergy to cortisteroids. I have had this neck issue for over 4 yrs. now. I had surgery because my C5/C6 was herniated and pushing against my spinal cord. I also had a couple bulging discs but they were not fixed. I have headaches daily, neck, shoulder and arm pain because of the nerve damage. Some pain and some numbness goes all the way down to my feet. I am on numerous medications to combat these issues. Any insight?
Tracie C


  • Ugh!! Insurance is driving me nuts at the moment....Back to you...

    What do you/they do in physical therapy that you couldn't do at home on your own or with some help? I did 9 months straight, 3 times a week, of physical therapy but my clinic at the time were very, very good at dealing with insurance companies. I hadn't been in this country long, it was one of my first experiences with insurance & I had no idea how hard it can get!!
    That physical therapist was over zealous & doing all the wrong things for my condition. She actually made me worse! When you total my $35-$50 co-pays that information brightened my day!! Sorry, it's one of those subjects I rant on too easily ;-)

    Anyway... My next new therapist was fantastic in every way. One of his strong beliefs was 'physical therapy shouldn't go on & on indefinitely'. He focused on training me to do exercises & stretches on my own. He provided written different routines for 'normal', 'increased activity' & 'major flare' management. These included using TENs & heating pads, aromatherapy & relaxation post workout. After the initial training he would see me occasionally to check my form. For years now I only see him when things have changed in my spine & routines need tweaking.

    Could that approach work for you? Do they do any special therapies, machine work that you can't get done without going into the PT office for appointments? The PT company gave me bands & an exercise ball & got me the TENs free of charge through my clinic.

    Hopefully if you still need to see them weekly they'll be able to justify it to your insurance companies satisfaction. As I said, the first one got my insurance to cover 'endless' PT for me but since then I've had my fair share of struggles with insurance companies. I often can't see any rhyme or reason to their judgements. So much seems to come down to how good the doc/therapist is at filling out the forms! If you get denied chat to your insurance co. before you take no for an answer. They've been very helpful on occasion...

    For me, I think it's vitally important to be doing the right exercises & stretches. I have to keep moving, if I stop everything becomes BAD very fast. I have osteoarthritis which makes activity even more important.
    Have you tried aqua therapy yet? It's on my to-do list. I really, REALLY want to try it. (I'll resist ranting about my insurance issues at this point!) Maybe insurance might cover that if they won't pay for more PT....
    Osteoarthritis & DDD.
  • I come from a European country where insurance is based on generational solidarity and I can get PT as much as needed, but the fact is that receiving specific treatments like magnetos, electrical streams, Sollux lamp, some weird energy waves and other similar stuff cannot be given indefinitely. What is the most important is the regular medical exercise and that's it. You can find another ways of self-help, like using TENS or going to sauna when you need heat. There are restrictions here too re number of therapies, so usually people can get it twice a year, but since my condition is bad then I can get as much as needed, but its not every day. There is a long "waiting list" of patients, so for example, I was examined by a doctor in February and then PT told me I can get an appointment for 10 days of therapy in May. That was earliest date offered to me "due to severity of diagnoses", because other people can get appointment in October only...

    In the meantime, I am undergoing intensive exercise therapy, swimming, using TENS and sauna, also taking tramadol and sedatives every day and feel somewhat better. I would say cervical and thoracic regions are fine (when compared what was with that 8 months ago), and lumbar area is better now, although sometimes awful. I will have my 10 days PT period starting in 7 days and then it will be decided.

    The problem in my country is not so much about how much you can get and about the costs (at least not so obvious as in USA), but the "waiting list" is so big so I would have to wait for MR scan for at least 6 months, its similar with CT. Now, if I would have an early stage of cancer, it would be discovered in fact only at the later stage when I would go to the ER and then it would be possible to be scanned earlier. I could always pay to doctors who work in hospitals and get examined in time. The corruption in healthcare system is high, so those who can pay by themselves are a priority, while healthcare system buys an expensive equipment for public hospitals.

    I have severe problems but I did not get MR yet, because first all PT methods have to be exhausted. It will be now my 3rd round with 30 more therapies, although I went through 80 already. If I would still feel the same symptoms (which is chronic pain in LS region btw.) then my doctor would be authorized to seek MR scan and I would wait for 6 months. After seeing what is there in fact, then I would be directed to neurosurgeon and also have to wait for few months. So, basically, I can get my final diagnosis/prognosis and suggestions for "better" therapy in late spring of 2016 at best.

    Knowing all of that; obviously I have no cancer since I am still alive, I decided to do whatever is possible to relieve my body from pain. I take the drugs (with less guilt if I get addicted), do the intensive exercise, swimming each day, request disability adjustments and wait. Its still better than it was in 19th Century. We all share the similar fate when it comes to capitalistic society and that's it.
    Scoliosis vertebrae THL
    Sy CC et CB
    Sy THS
    Sy LS chr
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  • I have all of the papers of the different exercises and I do them. Some of them I had stopped(and told him) because they caused more pain than helped. When I go in for therapy he works on my many trigger spots that cause most of the pain. Usually its more of those things that seem to be helping than some of the exercises. I assure you though that I am not in it for the massage (though it feels good). The biggest problem I have is when the pain in my neck and arms get worse, so do my headaches. I have not tried aqua therapy. I don't really have access to a pool and I cant afford to join a fitness club or even the YMCA
    Tracie C
  • Henry VIIIHHenry VIII Posts: 38
    edited 05/11/2015 - 9:49 PM
    That's really bad that you have no access to swim because at least that would help.
    Do you have any kind of social assistance there that may be helpful, something like a "disability benefit" with what you could cover the costs?
    Scoliosis vertebrae THL
    Sy CC et CB
    Sy THS
    Sy LS chr
  • dilaurodilauro ConnecticutPosts: 13,426
    The way that the insurance company continue to pay (or partially pay for the services) was that
    1) The Physical Therapist documented that the patient is still progressing and will require more sessions
    2) The Doctor writes a letter of medical necessity.

    Now, that always worked 5 years ago. Today, the Insurance companies and environment is a whole new game. But some of the rules still apply. I would try talking to your therapist and doctor about this. You have nothing to lose.
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
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  • 1028761102876 Posts: 248
    edited 05/13/2015 - 4:27 AM
    My insurance allowed me to transfer over speech therapy and sometimes occupational therapy appointments over. Is that an option? It was a life saver for me!
  • I will be appealing the decision on continuing the PT. I am getting ahold of my neurosurgeon and asking them to help me. I know their answer is " you shouldn't be having so much pain yet" but here I am. I don't like this anymore than anyone else does. I tried getting a scholarship for the YMCA last year but I still cant afford what they are asking monthly. Every other week I cant afford more than the mortgage and maybe $100 in groceries. I pay a lot of money per paycheck for insurance that eats up a good 2 days of work. I cant afford to miss work but yet I have missed quite a bit already this year. I deal with the pain daily but the PT is kind of a "body reset" to help get through a few more days until the next one. I don't know why I am still in pain. I cant go thru the injections like most people can because I am allergic to them. I was told that getting the appeal to be processed could take months...
    Tracie C
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