I have an insurance question about physical therapy?

Question

it may be apparent that what is wrong with my legs is something else, and it does affect the way i walk and i feel if i don't get this fixed soon it will make walking impossible. i have blue cross blue shield, what are the chances that they would make an exception to the allowed 40 visits a year?

Answer 1

40 visits a year is a lot. You should have either seen results by now with the treatment, or the cause of your symptoms may be from somewhere else such as the lumbar spine.

It will be difficult to get additional visits for the same area of treatment, however if another area is found to be the cause of your problem, such as the spine; you may have a chance. I suggest searching for a certified manual therapist in your area or an osteopathic Dr.

Good Luck

Answer 2

BCBS policies vary greatly.  We have some that allow only $2000 in visits a year for PT...others have no limit and are based on medical necessity.  

For those who've had a rotator cuff repair, knee replacement, etc, $2000 hardly buys them more than a few weeks of therapy....hardly enough to cover their needs.  (I can't wait until an ins agent who has one of these policies needs PT someday and they will see how ridiculous it is).  Most of these people file an appeal.  Yet, the appeal process is so arduous that by the time they could potentially get more visits, the damage (yes, I will use the word damage because that's what they are subjecting people to) is already done. It's ridiculous that they will pay for the surgery to be done, but not give adequate coverage to recover from that surgery.  Furthermore, I've yet to actually see someone on BCBS actually get more visits approved.  

Sorry to be so grim, but in terms of rehabilitation, most BCBS plans plain stink!  (I have it myself). I'd get on the horn now and start investigating.  Yet, if you've only had 15 visits, it sounds like you've got plenty of time.  

Good luck

Answer 3

It depends on the individual case. If both your ortho and PT can make a case of it would GREATLY benefit both you (physically) and them (financially) they might allow more. Some BCBS plans allow 40 visits a year per ailment, some it's a flat 40 visits no matter what. But, if the docs and PTs can make a case that, let's say, another 25 visits would keep you from having surgery and then rehabbing (read: expensive, in their eyes), they would probably go for it, I can't say for sure though. BUT, I would start investigating it ASAP...

Answer 4

maybe you should consult with an orthopedic doctor or chiropractor......