FORGOING MEDICAL REHAB NEEDS BECAUSE THE THERAPIST Doesn't TAKE INSURANCE – WHAT ARE WE MISSING?

I have been privileged to be a member of The Parkinson’s Resource Organization Wellness Village and speak at the Support Group meetings for the past four years. I’ve had an opportunity to meet many people with Parkinson’s and their caregivers. They love hearing about my approach to wellness because it is crafted specifically for the needs and disease status of the person with Parkinson’s and NOT dictated by insurance. When I inform clients or potential clients that I am one of many therapists (Physical, Speech & Occupational) that takes only private pay rather than Medicare or other insurances for payment they elect not to use my services but rather go for therapy that is less effective because insurance covers it.

WHAT ARE WE MISSING? I have clients who have Parkinson’s for over 20 years who attribute their stamina, strength, and longevity with the disease to the amount of personalized work we do together to keep them supple, moving, motivated, and inspired to work for wellness.

Among other modalities, I incorporate massage and the use of personalized essential oils in their therapy, and we do not work in 15-minute increments, our sessions include work until both of us recognize the benefits of our work.

Over the 30 plus years I have been practicing, I have found that insurance companies, by their pay standards, pay less for my services than I deem fair and appropriate based on my education and experience. By their pay standards, insurance companies limit the services I feel are needed, and that I use, to rehabilitate or keep a person with Parkinson’s symptoms at bay. In PRO’s July 2017 issues on Newsworthy Notes in an article called THINGS YOU SHOULD KNOW ABOUT MEDICARE by Dr. Samantha Peters, PT, DPT, ATC, she describes how insurance pays Physical therapy services billed in two different ways, “timed codes” and “untimed codes.” Just because I gave you a treatment that I told your insurance company was worth $140, they are not required to pay the entire $140. They can come back and say, well, that massage that I gave may have felt good (and may have been good for your circulation, may have decreased your stress, may have increased your mobility, and may have a multitude of other benefits), that is not a service that Medicare or Insurance reimburses, so we will not pay that $140. They can also say, well, you said that one unit of the exercise was worth $30, but we think it’s worth only $20. Yes, this happens all the time. Insurance companies also don’t pay your bill until at least 6 to 8 weeks after it’s filed. Additionally, insurance pays for a specific period (perhaps 12 weeks) when, because of the progression of the disease, Physical Therapy Rehab is necessary for much longer than 12 weeks.

Together, my clients and I determine the goals that are going to be the focus of treatment. We work toward those goals in a time frame that is suitable for the client. Private therapy can be flexible for changing priorities, goals, and treatment plans as needed. Most insurance programs are NOT that flexible. For insurance coverage, therapists need to adhere to guidelines concerning mode and length of treatment. Parkinson's clients have changing problems over time that need varying degrees of attention, changes in treatments and home exercise program adjustments.  Medical insurance is useful but may not be the entire answer for someone trying to stay mobile with a Parkinson's diagnosis.

If you are bypassing therapeutic remedies to maintain your wellness because insurance will not cover them, you quite possibly are missing out

Find Renee Gauthier, RPT, MPH in the Wellness Village where she’s been a member since September 14, 2015. She strives to build relationships with patients that are lifelong and trusting.