You pay your insurance premiums, co-pays, co-insurances so obviously your insurance has your best interests at heart and will cover any physical therapy needs that you and your licensed Physical Therapist deem necessary, right?
Um, no.
But the person at the insurance office who is deciding if you deserve to use your benefits for physical therapy is a Physical Therapist or Physical Therapist Assistant, so they know and understand the documentation and diagnoses.
Not likely.
But your doctor's notes and orders are reviewed by an experienced clinician and your benefits are assigned with your goals in mind.
Hate to break it to you......
You have no choice but to pay your premiums, co-pays, and co-insurances, all while America's health insurers raked in more than $41 Billion of profits in 2022, according to Penn Capital Star. Have your premiums gone up the last year? Did you know insurers actually DECREASE reimbursement rates for physical therapy annually? You would think this would equal you getting more care, but in reality, insurers are micromanaging providers and limiting visits in all settings, for all diagnoses.
Who are these pencil pushers deciding whether or not you deserve the care you and your provider feel is necessary? Most likely, it is AI. An algorithm that sets limits to benefits based on an averages. But what if you're not average? What if you have special needs or even wants? They are your benefits, you should get to use them, right? In this case, your provider can submit a request for more visits or do a peer to peer review to argue your case, taking precious unpaid time from your provider. Imagine if your provider had to do this for every patient, the amount of unpaid time is not worth the provider's efforts. But remember, insurers are reporting record profits and can afford the manpower to deny those efforts.
The amount of visits and reimbursement insurers approve has nothing to do with you, as a human, being able to reach goals that you have for yourself. They are not concerned with your desire to be able to play 9 holes without back pain, or being able to get on the floor to play with your children. They are concerned with the least amount of visits it takes to avoid a hospitalization or further doctor's treatments.
The phrase "If it's to be, it's up to me" is so powerful, I had it tattooed on my arm. If you are wanting more from your physical abilities than the bare minimum, you need to take control of your health care. It is literally up to you.
Benefits of Self Pay Physical Therapy with Custom Aquatic Therapy:
You and your therapist can decide how often you attend treatments. After an evaluation, a PT will discuss with you the most beneficial frequency based on your prior level of function, current deficits and problem list, and goals from therapy.
You and your therapist can decide how long you attend therapy. You will not be discharged before you are ready. Your PT and PTA will assess your need for more therapy at each treatment.
All treatments are one-on-one with your therapist. You will not be sent off to perform the same 6 exercises on your own while the PT or PTA works with 1 or 2 other patients. You get 100% of your therapist's attention.
Things happen. Sometimes you need to take a week off of therapy in order to go on vacation or attend to a family emergency. With traditional insurance, those missed visits could be used against you as "not following medical advice" and you would be forced to discharge or have your claims denied. Not so with self pay.
Each treatment is centered on your current status. With traditional insurance, it is expected to see progress at each visit or face discharge due to lack of progress. But with self pay, if you show up having a "bad day", your PT or PTA will work with you within your current ability and tolerance.
With self pay, you know your fees upfront. You will not be surprised with a bill because someone decided not to pay for a service after it was provided. You have total control over how much money you spend.
While self pay may not be for everyone, it can be a perfect option for many that feel they are not getting all they can from their benefits.
To schedule a physical therapy evaluation and to discuss your individual needs, call 314-730-0703 or email waterpt@customaquatictherapy.com.
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