How to get around Physical Therapy r/o

[vafoodie]

I know sometimes it's necessary but more often than not we've been hauling out somewhere and paying increasingly outrageous copays to do exercises we could do at the gym. On my husband's last stint, he had to pay 65% of every line item on his bill--10 minutes on the bike, 15 minutes pulling a stretchy cord, yada yada. We have recently gone to being self-insured, so this really hurts!
The last time I went to my ortho for my knee, I had to do PT before he could order an MRI.
Has anyone successfully figured out a way to avoid PT and still get the orthopedic testing one may need?

 

[ivinsfan]

See you are already letting the no insurance ( you can it self insurance if you want to) drive the health care bus. Are you not able to get a reduction to your outrageous copays?


To answer your question No...

 

[Kork13]

Yes! My wife is in DPT school right now to become a PT. Our kids & I are her training dummies (emphasis on the 'dummy'), and I'm confident that having a PT in the house will be very useful in the future to avoid many, many appointments.

The biggest things offered by a PT are the plan for how to rehab whatever injury you may have, training on how to perform each intervention to accurately target the injury, and how to progress your recovery plan as you regain function.

OP, you might see if either different insurance or a different PT would provide the services you need at a lower cost.... Or try negotiating down the copays.

 

[Sarah S]

If you are truly self insured then there is not the hurdle of documented pt to get prior authorization for an mri. That doesn’t mean you shouldn’t do it because pt sometimes is the answer ( why insurance makes you do it). If I had no insurance I would go to pt and spend 1-2 sessions having them design a program and then do it. This only works if you are knowledgeable enough about anatomy/ physiology to know if you are going off course. Or you could negotiate less frequent visits.

 

[ivinsfan]

If you are truly self insured then there is not the hurdle of documented pt to get prior authorization for an mri. That doesn’t mean you shouldn’t do it because pt sometimes is the answer ( why insurance makes you do it). If I had no insurance I would go to pt and spend 1-2 sessions having them design a program and then do it. This only works if you are knowledgeable enough about anatomy/ physiology to know if you are going off course. Or you could negotiate less frequent visits.

Maybe if the doctor signs off on it....because you are assuming the only reason for the PT is the insurance company.

 

[Midpack]

I’d try to find and work with a physical therapist who will work with you to come in for a first session, and some intermediate evaluations if necessary - while letting you do therapy on your own as well if no special equipment is required. It would be a mistake to replace a qualified PT with Dr Google, but I can understand why it might not be necessary to go to a PT site for every session. Unfortunately the bean counters at the site will want to extract as much $ from patients as possible even if the PT doesn’t. My wife had PT after ankle replacement surgery and it was amazing how she needed exactly the same number of PT appointments as insurance would pay for (10 IIRC), after which she could do therapy at home on her own…

 

[pacergal]

Many joint ailments heal well with PT, many don't and need further testing.
Docs generally go with the least expensive and less invasive first.

Last time I had PT, the therapist worked with me, showed the exercises, had me do them so she could correct anything, then sent me home with pictures and instructions.
I had 3-4 sessions, then I said I was OK and would come back if needed. She was good with that.

I think the Dr wants to see if the exercises help, doesn't matter where you get them done. Can you ask your PT to give you home instructions to do and stop going?
Do the exercises for 3-4 weeks in your gym to see if any improvement, then go back to Dr.

 

[Teacher Terry]

I have went a few times and once I had the exercises down I just did them at home.

 

[Donno]

I have a real thorn in my side over PT. Several years ago I had a frozen shoulder and my family doc sent me to an orthopedic doctor. He examined me and said I needed PT before he would do anything, so I dutifully went to PT 3 days a week for a month and then 2 days a week for another month. After 2 months with absolutely zero improvement and thousands of dollars in co-pays, I went back to the ortho doc, and he gave a cortisone shot in my shoulder. Two weeks later I was pain free and within a month I had full range of motion. A few years later my other shoulder was frozen, and I went back to the ortho doc, and he told me I needed PT and this time I told him I wanted a shot of cortisone, and I wasn't wasting my money on PT for no reason. He gave me the shot and I got the same results while not spending a fortune on PT.

I'm sure PT has uses in a lot of cases and I certainly wouldn't rule it out, but there are a lot of exercises that can be done at home or a gym for very little money.

 

[Aerides]

OP if you are self-insured, make it clear to your Doc you are a retail customer, and not bound by the pre-reqs of an insurance plan. If that doesn't work, try another Doc.

(but why....)

I do agree that getting a better diagnosis should not be held up for PT, which may not always help and may sometimes make things worse...or just leave you in pain longer.

So if I'm ever held up like this I'll ask what is the minimum amount of time/sessions required, and do that. I have a PT place near me that I like, but my insurance rates (high deductible) are almost as much as a walk in. I would never accept doing PT before getting a cortizone shot. I would pay for the shot before I'd wait weeks. I'm always "how about both"...

 

[braumeister]

I'm surprised at the requirement.
DW and I have each gone to an ortho several times in recent years for various things, and it's always an X-ray first, then an MRI. They have never even mentioned PT. This is with Medicare, but in years past with employer insurance it was the same way.

I did use PT once for a sort of carpal tunnel situation, but I agreed it was the appropriate approach.

 

[Callitaday2022]

Negotiate with PT if required, but not sure why required if you are truly self insured. Our cash pay rate is only $75.60 all inclusive. Includes exercise, neuro re-education, soft tissue, joint mobs, dry needling, etc...

 

[skyking1]

That is " new doctor" time in my book. I have had great results with post surgery PT on both shoulders, and a back strain.
When the doc does not have a handle on your diagnosis, beware.
My one bad experience, an ortho sent me to PT after a knee injury. It hurt and did nothing. My next doc said you need surgery now!
PT will not heal a bucket handle tear of the meniscus

 

[Geld ist Freiheit]

Negotiate with PT if required, but not sure why required if you are truly self insured. Our cash pay rate is only $75.60 all inclusive. Includes exercise, neuro re-education, soft tissue, joint mobs, dry needling, etc...

Definitely try this. I was getting great PT from a place I liked for a recent injury. I asked about getting some sessions for an old unrelated injury. I mentioned it would probably be without insurance. He said he had 12 people on staff that did nothing be process insurance claims and it took at least 90 days for him to get paid. If he could get paid today without having to plow through the insurance process he could afford to charge A LOT less.

 

[mystang52]

I have good insurance so, at most, I'd be subject to $10 co-pay each PT session. My experience, though, has been that PT very often accepts insurance payment as full payment, provided you come to that agreement before starting PT. At the least, one may be able to negotiate a lower co-pay. I don't know for sure, but I believe that often insurance requires PT before approving surgery or other procedures. If I knew that PT would be a waste of time, I'd do the minimum (including periodically cancelling a PT visit in advance) before returning to the doctor and stating the PT wasn't effective.
Finally, when I have used PT it has helped me, but no doubt due to the fact that I'm a good patient and do those exercises at home as well. I think PT's main benefit is giving a routine to the patient who otherwise would not do the exercises.

 

[HawkeyeNFO]

Part of the Medical Industrial complex.

Ever notice that hospitals and medical complexes are always putting up new buildings? Even in run-down, post-urban cities.

 

[Sunset]

When I had the terrible insurance. I just phoned open MRIs to ask the price and went. No doc required .

My ins only paid a flat $300 for an MRI.

 

[ivinsfan]

When I had the terrible insurance. I just phoned open MRIs to ask the price and went. No doc required .

My ins only paid a flat $300 for an MRI.

I don't know if OP has terrible insurance but they apparently came from the world of work provided insurance with tiny co pays and low deductibles ...it's a learning curve...

 

[vafoodie]

I don't know if OP has terrible insurance but they apparently came from the world of work provided insurance with tiny co pays and low deductibles ...it's a learning curve...

Exactly this. A painful learning curve.

 

[MichaelB]

Exactly this. A painful learning curve.

On a positive note, good thing it is happening with PT and not something much more serious - and expensive.

We have recently gone to being self-insured, so this really hurts!

Health insurance is expensive, and self-insurance for health care is risky. Hopefully you have a “Plan B” should you require significant and costly treatment.

 

[Koolau]

I have a real thorn in my side over PT. Several years ago I had a frozen shoulder and my family doc sent me to an orthopedic doctor. He examined me and said I needed PT before he would do anything, so I dutifully went to PT 3 days a week for a month and then 2 days a week for another month. After 2 months with absolutely zero improvement and thousands of dollars in co-pays, I went back to the ortho doc, and he gave a cortisone shot in my shoulder. Two weeks later I was pain free and within a month I had full range of motion. A few years later my other shoulder was frozen, and I went back to the ortho doc, and he told me I needed PT and this time I told him I wanted a shot of cortisone, and I wasn't wasting my money on PT for no reason. He gave me the shot and I got the same results while not spending a fortune on PT.

I'm sure PT has uses in a lot of cases and I certainly wouldn't rule it out, but there are a lot of exercises that can be done at home or a gym for very little money.

So glad it worked out for you in the end.

I had sort of the reverse situation. I went in with shoulder pain and the doctor ordered an x-ray. He said I had an impinged shoulder and, when a cortisone shot failed to help, said he could fix me right up with surgery. I asked him if we couldn't try PT first. He reluctantly sent me to PT. The therapist diagnosed the cause (not the name) of my problem in 2 minutes. She tailored exercises and taught me tricks to use to prevent the pain. All these years later, shoulder is fine and I know what to do to prevent a recurrence.

Agreed that PT is expensive and not always effective. In general, I favor the simplest, least invasive treatment first. YMMV

 

[Aerides]

I went in with shoulder pain and the doctor ordered an x-ray. He said I had an impinged shoulder and, when a cortisone shot failed to help, said he could fix me right up with surgery. I asked him if we couldn't try PT first. He reluctantly sent me to PT.

I absolutely agree you should do a full course of PT before surgery, but not before diagnosis, which an XRAY can't always show. Some body parts, yes, in particular a shoulder, as you can do certain moves that are "tells" to any decent ortho. Move it that way, aha it's this, the other way - oh it's that.

PT is only as good as the patient. I remember diligently doing some silly exercises while the woman next to me just kept complaining and stopping. Guess which one of us avoided surgery...

 

[Badger]

Many joint ailments heal well with PT, many don't and need further testing.
Docs generally go with the least expensive and less invasive first.

Last time I had PT, the therapist worked with me, showed the exercises, had me do them so she could correct anything, then sent me home with pictures and instructions.
I had 3-4 sessions, then I said I was OK and would come back if needed. She was good with that.

I think the Dr wants to see if the exercises help, doesn't matter where you get them done. Can you ask your PT to give you home instructions to do and stop going?
Do the exercises for 3-4 weeks in your gym to see if any improvement, then go back to Dr.

+1 for the therapist to get base line data for a few sessions and then going home with picture instructions and stretchy bands before returning a few weeks later. Sometimes the instructions will need to be updated or new ones recommended. The PT may also want to increase the strength of the elastic bands.
I have been to PT for every major joint in my body except my hip and finally constructed a 6' post with eye-screws every 1.5 feet to attach my elastic bands with a carabiner to do all the exercises. Easy to make and convenient to use at home. A 2X4 bolted to the wall for the eye-screws would also be easy to make. You can also get additional elastic bands or tubes at Amazon or a sports store.

Cheers!

 

[pacergal]

+1 for the therapist to get base line data for a few sessions and then going home with picture instructions and stretchy bands before returning a few weeks later. Sometimes the instructions will need to be updated or new ones recommended. The PT may also want to increase the strength of the elastic bands.
I have been to PT for every major joint in my body except my hip and finally constructed a 6' post with eye-screws every 1.5 feet to attach my elastic bands with a carabiner to do all the exercises. Easy to make and convenient to use at home. A 2X4 bolted to the wall for the eye-screws would also be easy to make. You can also get additional elastic bands or tubes at Amazon or a sports store.

Cheers!

Great idea! All of my stretchy bands are in a basket near my yoga mat. I have to find the right table, door knob or chair leg to attach them too

 

[homestead]

So glad it worked out for you in the end.

I had sort of the reverse situation. I went in with shoulder pain and the doctor ordered an x-ray. He said I had an impinged shoulder and, when a cortisone shot failed to help, said he could fix me right up with surgery. I asked him if we couldn't try PT first. He reluctantly sent me to PT. The therapist diagnosed the cause (not the name) of my problem in 2 minutes. She tailored exercises and taught me tricks to use to prevent the pain. All these years later, shoulder is fine and I know what to do to prevent a recurrence.

Agreed that PT is expensive and not always effective. In general, I favor the simplest, least invasive treatment first. YMMV

Once had a surgeon tell me "When you are a hammer every problem looks like a nail" meaning he could fix my problem with surgery but he gave me an Rx instead.