A son or daughter (or in-law) will frequently have to take over care for an elderly relative, without any advance notice. Due to the number of alternative plans available today, well-meaning relatives could easily find themselves buried by a mountain of medical bills.
Many senior citizens these days have selected a commercial policy in place of Medicare. Why? Because the benefit plan under a private Medicare plan has been “rearranged” in a way that works better for some people.
While Medicare has a deductible and coinsurance, a pharmacy plan with a “doughnut hole” coverage gap, and no vision benefits, a private Medicare replacement plan may have a copayment (more expensive) for professional services, but includes vision benefits and no prescription medication “doughnut hole.”
BEFORE YOU HAVE TO CARE FOR YOUR ELDERLY RELATIVES conduct a yearly review of medical benefit plans. The Medicare Open Enrollment Period is usually mid-October to mid-December, so brief meeting at Christmas could save you thousands of dollars in uncovered medical expenses. At a minimum, get the following information:
- All insurance company and plan names. An example would be “AARP – Medicare Complete”
- All individual member and group/plan identification numbers, including Medicare/Medicaid numbers
- All customer service contact numbers
- Copies of all applicable plan cards
When calling to schedule an appointment, make sure you provide the applicable plan name, rather than “Medicare.” For example, if your Dad has a Humana Medicare Advantage plan, don’t say that he’s covered by Medicare, but clearly state that he has a Humana Medicare Advantage plan. Some clinics will accept Medicare, but not Humana, or vice versa. Make sure the clinic you are visiting has providers in the network plan for the insurance plan you will be using.
The American Physical Therapy Association (APTA) has released it’s statement regarding the transition from Cigna to American Specialty Health physical therapy contracts:
APTA sent a comment letter to CIGNA summarize concerns regarding the Cigna National Physical Medicine Clinical program’s use of American Specialty Health (ASH). Here are some of the points APTA shared with Cigna:
- ASH has limited physical therapy experience and it does not have the requisite expertise to render appropriate clinical decisions regarding medically necessary physical therapy services.
- The ASH Provider Agreement (Agreement) is overly complex, difficult to follow, and will not be readily understood by most therapy providers.
- The Agreement’s payment methodology imposes a burdensome and one-sided appeals process.
- The ASH provider tiering mechanism as described in the Clinical Performance System is unduly complex and arbitrary, and it is not keyed to clinical outcomes.
- The Agreement’s administrative features are burdensome, including the MNR process and the obligation to check the Medicare exclusion list monthly.
- Utilization management under the Agreement calls for non-PTs to review appeals of adverse decisions, and it is not truly evidence-based, since it relies on Clinical Practice Guidelines (CPGs) selected by ASH via a process that does not meet APTA standards.
Cigna terminated all contracts with physical therapists in this area on September 1, 2014. We are now required to go through a third party company – American Specialty Health (ASH) – to obtain authorization and payment for physical therapy. Although this has been in process for months, we received our welcome packet only last Friday, and have yet to be provided with a full online account and instructions on how to obtain authorization and treatment for Cigna patients. Read more
Approximately 10% – 15% of our therapy is provided to patients who were injured in a car accident. This area of therapy is rife with fraud and abuse, partially due to the rules regarding these claims, partially due to abuse of those rules, or the situation in general. We provide ethical, evidence-based treatment to all clients, and charge all clients the same, fair price for our services. Read more
Athletic tape, acupuncture needles, and a TheraBand Flexbar. What do they have in common? Combining old school, ancient and new age treatments can save money and provide better patient satisfaction. Read more
This is something that goes unsaid in my office, but I can read it on the faces of patients. Today’s patient had suffered 6 months of nagging headaches and neck pain. After a few visits to the doctor for NSAIDs and muscle relaxants, he was referred to a neurosurgeon and pain management physician, an MRI was ordered, and his neurosurgeon referred him to see me.
3 visits into his therapy he has no pain. In fact, he had only minimal pain after the second visit and seemed a little paranoid that it was all just too quick and easy. After today’s visit, it makes sense to him, but he still seemed to want a more complex explanation. A few exercises and that was it. How could this be?
The master mechanics turn the same wrenches on the same bolts the same way. All the automated diagnostic help in the world (for cars or people) still can’t beat a mechanic’s fundamental knowledge of how something works, when it comes to getting something fixed quickly and easily.
I have no explanation for why neck pain and mechanical headache required waiting for neurosurgical and pain management referrals and an MRI. That’s a complex answer I don’t have. On the other hand, his pain was localized, symmetrical, and mechanical. That’s easy for most therapists.
I should have made something up about scoliosis, his “hip bones being out,” trigger points, or “compensation” for something like his wallet, and he might have found that more satisfying, lol.
I recently received a voicemail message from a former patient (whose son I had also treated) asking if I practice a specific proprietary, trademarked, and well-publicized technique. I responded via email, and then realized that this response could have been written a dozen or so times over my previous 17 years as a therapist, so I ought to just make a generic letter regarding all such techniques:
I hope you and your family are doing well. ____ is a proprietary treatment approach that incorporates very good marketing resources, with very expensive tools and educational materials, and is a treatment technique very similar to many other techniques that have been used for tens, if not hundreds of years.
Despite the hype, _____ has yet to demonstrate it’s effectiveness as a technique above and beyond other techniques. I just checked their website (figuring that I would find the most favorable literature there) and found a list of published case studies, most of which were single case studies. That means that as a “new” treatment, it was published in a peer-reviewed journal or magazine, with the data from only one patient that was treated using the technique.
Although they tout a presentation they put on at a_________ meeting, that research has yet to be published in a peer-reviewed jorunal. I’m not sure it ever will. There is no date regarding what year the presentation was made.
They have an effectiveness chart for ______ that looks very impressive, but again, it does not compare the effectiveness of their technique to any other treatment, and in the fine print states that their outcomes include treatment that is comprised of other techniques with _______ being only a portion of the total treatment.
Other research on their site is included if it mentions _______ in passing, as a “new” or “alternative” technique for a particular problem.
Without any randomized control studies, nor any other comparative data to demonstrate effectiveness, I will not be taking their courses or touting their trademarked name or logo, unless someone offers it to me free of charge. The same treatment techniques have been taught to physical therapists (including me) for decades, but without the same expert marketing panache.
The generic term for this kind of treatment is _________ and does has proven effectiveness in very limited circumstances. I practice __________ on selected patients, based on evidence of effectiveness. I select a technique if can I get a better result with it, or can I get the same result as other techniques, but with fewer visits or expense for the patient.
Hope this clears some things up. Some physicians – especially sports medicine physicians – are perennially sold on the latest and greatest technique, only to move on to the next new thing a few years later. I wish that more would read the scientific literature, or simply find a therapist whose judgement they trust, rather than chasing after the latest fad. Unfortunately, many therapists have simply given in, and pay exorbitant fees for these classes, so that they can claim they provide a proprietary technique, even if they know it to be ineffective. It’s simply a marketing decision.
So….call me to ask if I can treat a particular problem, and ask me my opinions of the technique. Allow me to use my best judgement and the most current information, and I can give you the best outcomes possible. If things are not working out as planned, I have several “alternative” tricks up my sleeve as well that may be helpful, and I can route you to the person who can ultimately solve your problem if I cannot.
Fear, Avoidance, and Beliefs negatively impact patient care on a daily basis, however, they can be helpful in recovery when properly oriented an placed in perspective.
As you may or may not know, we’re looking to hire a physical therapist and/or licensed physical therapy assistant. If you’ve read over our website, checked our facebook page, or been a patient, you’ll understand that our focus is high-quality work: getting patients back to their lives as quickly as possible, or finding them the correct solution for their problem.
A Therapist’s (bad) Sales Pitch
I discussed this philosophy with a therapist who contacted me about working here. During our discussions, however, he still wanted me to know that his patients, on average, attended more physical therapy visits than did patients of other therapists in his company. He considered this a selling point.
Ha! Think how successful I would feel if only I would work to increase the number of visits each patient had to attend!
Watered Down Medicine
Right now many therapist are paid, directly or indirectly, on how many visits their patients attend, rather than based on the quality of their work and the service they provide their patients. The majority of them are in physician-owned therapy clinics. They provide physical therapy by proxy, many times without a therapist on site.
Imagine paying what you pay for therapy, and arriving for each visit, knowing that the person working with you was working with multiple patients simultaneously, not licensed to perform any particular services, could not assess your condition and change your treatment plan, and was not directly supervised by someone that could either! Think of all the time that would be wasted…and all of the additional visits generated for additional revenue.
It’s like a pharmacist watering down your medicine, so that you have to buy more of it in order to get well.
How I Want To Earn My Living
Patients are never a number or statistic to us: they are people who have brought their problems to us for a solution. If that solution is not going to be therapy, we will discover that quickly and direct you to appropriate care. If the solution is therapy, we will work as hard as possible to solve your problem as quickly and as painlessly as possible, so you will come back with any other problems, and refer friends and relatives with similar problems. We have, and will continue to structure our insurance contracts to reward us for quality care – paying us more for effective treatment, rather than paying more for watered down cough syrup.
We currently have openings for the following positions:
Do You Know…
- Someone suffering from vertigo?
- An athlete still feeling the effects of a concussion?
- A parent or loved one that seems to have “lost a step” with respect to getting around safely?
Get Definitive Treatment Now
Balance problems and dizziness can impede anyone’s lifestyle, however, in most cases, it can be addressed quickly and relatively easily with a few simple activities at home, and some work in the clinic. Contact us for an expert evaluation, customized program, and personal attention!
Every month we receive calls regarding patient statements. Most of the questions we are asked are very similar, and fall into the same major categories: Read more
An Observer Program for Those Interested in Physical Therapy
As a result of my experiences – good and bad – with physical therapy observations, I decided to come up with a framework that will allow someone truly interested to “take the bull by the horns” and benefit, while at the same time, giving me the ability to write a thoughtful and thorough recommendation for those that wanted one.
From time to time, we may have to issue a refund for a patient or insurance payment. The terms for refunds vary, based on the circumstances. Read more
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If you have any questions, please contact our Privacy Office at the address or phone number at the bottom of this notice.
Therapy Services Provided: “Orthopedic Spine and Sports for All Ages”
We specialize in outpatient orthopedic rehabilitation of all types, and for all joints.
Physical therapists get a bad rap when it comes to pain. Sometimes pain is necessary for recovery, however, saying “no pain, no gain” goes too far. Although I’ve addressed the role of pain in therapy, and used the term productive and unproductive a thousand times related to pain, I never thought to put it down on paper (in cyberspace) quite that way until the other day.
Can Anyone Really Explain This?
This is the best way that I can think of to explain how medical services are billed and paid for, and it’s by using something that everyone understands – a restaurant.
Read This First
This is a very interesting article, and I think that any patient that is planning to undergo physical therapy should read through it. After you’ve read it, I have a few (ok, more than a few) comments:
What is a Username?
A Username on facebook is a shortened URL that allows others to easily find a facebook page.
While individuals were able to obtain usernames over the summer (maybe before that) business pages initially had to jump through some hoops.
I have recently started doing “Utilization Peer Review” work in my spare time. I wanted to ensure that I was acquainted with all aspects of the workers compensation system, and to be honest, I was a little curious to see what other clinics were doing. UPR means that I spend some of my time each week working on a contract basis for insurance companies, reviewing the work of other therapists, and making recommendations regarding the appropriateness of proposed future care.
Well, it’s been extremely revealing, and leads me to today’s post about treatment expectations.
The information on this Web site is provided by Terry Rehabilitation & Testing for educational purposes only. It is not a substitute for professional medical care, and medical advice and services are not being offered.
If you have, or suspect you have, a health problem you should consult your primary healthcare provider.
Terry Rehabilitation provides links to other organizations as a service to our readers; Terry Rehabilitation is not responsible for information provided in other web sites. Read more
So What’s New?
I was working long through a Saturday, and low and behold there was an informercial for a local group of chiropractors advertising their spinal decompression treatments. They featured an orthopedic surgeon from Georgia. I looked him up, and found that he had been stripped of his board certification because of a felony fraud conviction related to a spinal decompression device. Read more
This post addresses general rules and FAQs for referring patients with orthopedic problems to physical therapy. To take a look at our Referral Guideline, click here.
How Do You Know When to Refer?
Well, this is an attempt to help you arrive at a decision with your patient’s best interest at heart, relying on evidence (peer-reviewed studies, quality assurance studies), experience, and situational considerations.
In some circumstances, Terry Rehabilitation & Testing, Inc, may be able to extend a discount to those without health insurance coverage or those with a bona fide medical/financial hardship.
What is a “Frozen Shoulder?”
Frozen shoulder syndrome entails the progressive loss of both passive and active motion. It’s cause(s) (etiology) is not well understood, although significant risk factors include age, posture, diabetes, presence of neck pain, and sedentary work. In a frozen shoulder, the covering of the shoulder joint, called the joint capsule, becomes inflamed, very painful, and tightens up around the shoulder. An article was published in the October issue of Physical Therapy comparing mobilization techniques in the treatment of frozen shoulder.
Do You Accept ____ Insurance?
As a general rule we accept all forms of health and auto insurance. However, there are certain networks to which we cannot gain membership. We encourage providers to refer patients based on the high quality of care they receive in our clinics, regardless of insurance status. Read more