How long does insurance cover your PT?

[tc]

My insurance doesn't pay for more than 3 months of visits to a physical therapist for each diagnosis or body part in a lifetime. For example, I had 3 months of therapy last summer for the new spinal cord tumor diagnosis. Now, I still need therapy, but I have to find someone else (outside the hospital) to do it and I have to pay for it myself. When I read many of your posts, it sounds like some of you have continuous PT. Does your insurance cover that? I haven't had surgery yet, but I have chronic neck pain and use a TENS and take prescriptions . . . but it sure would be nice to get therapy too. It doesn't seem right that insurance ends, even though the condition continues.
Teresa

[Joel]

with my insurance, all I need is for my primary care doc to say I need PT and I get up to 90 days. Then I would need to visit him again to get another prescription for another 90 days. I can keep doing that forever if I can convince my doc I need it.

[joanne]

my insurance allows a certain amount of sessions of PT per year. period. Not per diagnosis.

[bethann]

I have just changed insurance... I had Priority Health (In Holland Michigan) at that time and now also that I am on Blue Cross (still in Holland Michigan). I am able to receive around 60 PT appointments a year. Right now I go every other week. Sometimes I have called and received an appointment on the week I have off... if I needed it. As long as my doctor keeps signing the requests for more therapy then I will be able to receive it. This is called chronic care. I do not know how I would deal with the pain if I did not have PT!

Beth

[cindylee]

Hi..I was scheduled to receive something like 36 visits as an outpatient. But my insurance kept tabs on me and did reviews. When I got to the point where I could walk so many feet and was making steady progress, they cut me off after 13 visits. I did not fight this because I had so many other things going on at the time. They gave me the stretchy bands and a God Bless and sent me on my way. I really could have used a little more PT. I now have Blue Cross/Blue Shield PPO Blue, so I would hope that if I needed it, PT would be available to me. At the time, it did not matter that my doctor wanted me to have therapy...insurance said I did not need therapy according to their set of standards. I could not fight it so I struggled on my own. Cindy

[8338]

I really had PT a long time ago (5 yrs) so I think it was about 3 months- forgot how many visits that was. What I go to is something called the Open Gym Program at the PT place for former patients to come in as many times a week and whenever they want to work out on the machines. I don't know if you can use the pool though. What I like is that there are PT's around helping other people and I think if you needed some advice on what or how to do an excercise or something bothering you that they would give you the advice.
My ins., Independent Health, covers 1/2 year gym membership. So I wrote them and said that this is the only place that I could work out and it keeps me mobile enough to make it into work every day. So they cover 1/2 year. ;D I end up pay $150.
Barb

[Tmasgio]

I have the same rules as Joel. Just need to convince the DR. I need it but really alot of those exercises I do at home and more.

On a side note: I think all of us need to exercise daily or have some Range of Motion plans even if you cant go to PT. This is vital to not letting our bodies atrophy.