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Reflex Sympathetic Dystrophy (RSD and CRPS) Reflex Sympathetic Dystrophy (Complex Regional Pain Syndromes Type I) and Causalgia (Complex Regional Pain Syndromes Type II)(RSD and CRPS)

How do you manage PT and insurance?

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Old 12-14-2008, 02:32 AM   #1
lindkaye
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Default How do you manage PT and insurance?

As if I am not having enough "fun" with the knee and RSD, my husband's company has changed health insurance last month. With the old insurance, I could have, I think, 18 visits or so for PT. I also had my own insurance from my past employer up until September, so it was not really an issue. But now we are down to just my husbands insurance. Now, the new insurance is giving only $1,500.00 per year for PT. Thats it - only 1500 no matter how many issues you have with different body parts during the year. I know from going to PT that it can be up there $ for just 1 visit - alot of things are itemized for $. I am really stressing and feeling like just giving up. I just had my open debridement on my knee to get the scar tissue out to try to move the knee and regain my flex so maybe I can walk down the stairs normal and drive again. With the RSD in this knee, its a battle for every degree of bending. All the drs have stated that PT is the #1 thing I should be working on. My new therepist I found 2 weeks ago is so nice and knows about RSD - and now I find out that for all of next year I probably will only be able to see him, I'm guessing, maybe 8 times if that for all of next year? I know I can, and do, PT at home, but I feel I still need the extra help of the therepist, especially with the RSD. Paying out of our pocket is not an option. I have had to be off work since Feb of this year. My husband last year had Advance Prostrate Cancer (thank god he is ok now after surgery), and my mom who has dementia lives with us - so we have had our share of "fun stuff" and financially its really tough, like many people. But I know its mainly my fault for not being able to work, which makes me even madder at myself. I have filed for disability - but which year (if any) I am approved is up for grabs. I guess I am just being "humbug for the season"! Your thoughts and advice are most appreciated as I am getting so discouraged at this point. Thanks.
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Old 12-14-2008, 04:12 AM   #2
llrn7470
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Lindkaye-Here's a tip that may or may not work, but likely worth your time. My sister works at a PT office and they have several cases where patients cannot pay, but the PT clearly sees need. They refer to the hospital who picks up all or part of the cost under some fund (hospitals have an obligation to help those in need regardless of ability to pay, have women's auxiliary groups that raise money for funds, etc.) Ask about that. Or, you could do what I did. I went into my PMR office and announced that I was no longer going to PT because even with insurance paying, my copay was $15. Sounds reasonable, except he wants me to go three times a week, whick ends up being $180 a month. Your doctor can appeal to insurance for lots of things. If meds arent' covered, out of group specialists, etc. But you have to ask. These phone calls are hell for them. They are essentailly trying to convince a high school graduate on the other end of the line with no medical training whatsoever to give them money. If he does it, send a nice muffin basket. I assure you, it's like reasoning a favorite toy from a two year old through logic.
Hope that any of this helps-hey maybe we can get some PT sessions in your stocking this year, but not if you're a humbug!
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Old 12-14-2008, 12:27 PM   #3
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Heh llrn, that is a great suggestion! It really helps to have someone here who knows the medical system from the other side. Glad to see you have so much spunk.

I lost my extended medical 3 years ago when I lost my job, so as a result no more PT, fortunately my hospital pain program continues to take me in for tune ups. The rest of the time I try to continue with their recommendations on my own. Last week I picked up a really good stretching video from our library and I find doing that at my own pace has been really helpful. Don't get discouraged lindkaye, as llrn said there's a good chance that you could be referred to a hospital program. Consider asking you current PT to give you a program that you can easily do and follow on your own between your covered appointments. I'm sure you will end up with a big bag of inexpensive PT tricks that you can easy dip into when needed.

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