I have a rather challenging year with my knee having had two meniscectomies and a ACL replacement.
Needless to say after each surgery has been a round of therapy trying to get it to recover.
The insurance companies want to limit the amount of physical therapy you get so you have to apply for permission to get therapy each time.
So after this latest round they have so far refused to approve therapy and "have it in review".
Their benchmark for review is 15 working days.
After surgery, you normally wait 10 day for things to calm down before starting therapy which is when they do an appraisal to submit for coverage.
So if we add 10 days and then three weeks we're at a month from surgery before they are willing to approve physical therapy.
Of course that is if they decide to approve it. My guess is they blow me off and take it under review for one more round.
If they can delay it long enough they won't have to pay a claim because I won't need therapy anymore, just another surgery to repair the damage caused by lack of therapy.

I am just so pissed at these guys right now.

 

I would call the Insurance Comissioners office and get their input.

 

Ah, we were close to being in your shoes once. They are not comfortable shoes. When Rick had his shoulder surgeries, his PT visits were limited to X per year. No way around that one. It was written in the policy.

We had no idea one surgery would turn into three and the only reason he received almost enough PT was that the first surgery was in a different calendar year.

He had surgery in January (#2) and March(#3). He was getting close to using up his visits for the calender year not long after the second surgery. He stretched out the time frame on the visits, did most of his PT at home, with just the occasional visit to the therapy place.

I was really pi$$ed when I called to ask our cost if we paid for the PT and was told it was at full price, since we didn't have a contract with the hospital. I know full well the insurance company only paid 1/2 of the charges for his visits.

We were told, in days gone by, they allowed PT for each occurrence. Broken arm got you X number of visits. Break a leg and you get X number a visits. Then they rolled in all into one. So if you got 20 visits per calender year and used them for a broken arm, tough luck to you if you broke a leg.

 

Yah, they pay bonuses to their people who wrap you around the axle, dwelve in the fine print, and exhaust you into giving up.

 

They deny if they can, then make you twist in the wind while they review.

 

trust me I studied risk management insurance while in college.

I am just getting wound up into full Flaming A-hole mode.

Don't make me angry, you wouldn't like me when I'm angry.

I understand far more than the average joe the plumber

 

Do you really need more than a few visits? For my shoulder some years ago, and for both knees, I went to 2 sessions, then the PT wrote out my daily exercises for the next couple months, then one more visit to see how it's going. He gave me some exercise bands of varying strengths, and made sure I knew what to do. (Note that I asked for this rather than this being standard).

Sure kept the visits down - for the second knee, I had one session as a refresher, then just one more a month or two later. He knew I knew what to do.

JonasM

 

Depending on the injury/surgery, you could need more than a few, and you certainly would need an evaluation prior to starting PT. As I said Rick stretched his visits and did much of his PT at home.

That only works for those who WILL do the PT at home.

 

Pt is good at providing the independent assessment to gauge progress.
I tend towards type A ( or so I'm told ) so it is good to have the tour guide so I don't over do it.

I have started on PT at home and I am pleased with the progress so far.
But one of the things that the surgeon told me is that you have to be very careful with transplant tissue since it is easier to damage than your own.

 

You don't mention your insurance company by name. That's too bad. I am ready to add them to the list of ones I hate and will never NEVER forgive for what they did here after Katrina. That list is lead by State Farm and Nationwide. I share your anger.