Hi everyone- I am currently seeing my pt only twice a month. I do edge low and other exercises at home. I began pt in may 2012. My insurance co did ninety days and then began rejecting claims. I appealed and got. Coverage through September 2012. However I had more tests in jan 2013 and saw local docs and then dr Donahue. Both recommending continuing pt due to improvement although I still am not normal of course. Dr d said this would probably be lifelong. I have a number of other conditions that make the surgery more risky for me. I am now doing another appeal. Any advice? My plan covers unlimited pt visi st if it can be shown to be medically necessary. Thanks!

As always the "squeaky wheel" scenario. Ins company's only approve 24 weeks per calendar year. Any additional the cost is on us. Unless you have a worker's comp type case brought forth can you appeal and ask for continued. Most PT places offer a 50% discount for cash. It's not fun but a necessity for us

My plan covers unlimited PT visits as well. My PT does a progress report after about 12 visits and then I get a new prescription from the surgeon or pain management doc. I sometimes take a couple weeks off from PT before returning between prescriptions (I'm on a break right now). I've never had an issue using this approach.

My PT was only covered for 30 visits, nomatter how many prescriptions I got

And i didnt find out until after i had been. There's no preapproval process, it's disgusting

Marc- that is a great idea. Get new prescriptions. But of course I have from last September until now to deal with.

It is so ridiculous because of course I would prefer not to be spending my time doing pt and it hurts! Each time I cry.

My previous insurance company was horrible in regards to physical therapy. I had to call after each session as every single bill was "pending additional information".

For me, Marc's suggestion of new prescriptions and taking a break in time did not help. My plan allowed 60 visits a year but I highly doubt they'd cover 60 visits. What would trigger the medical review was 25 visits of PT over the entire time with the insurance company (not plan year) for any diagnosis code. It would generally take 60 to 90 days once this medical review period hit. Even though I'd only had about 12 sessions after the TOS surgery, I eventually gave up on physical therapy and stopped going.

What insurance company do you have?

Yikes, what kind of things are they doing for you, or having you do?
What parts of the PT sessions hurt?

What type of TOS do you have nerve or vascular? combo? or RSI type?

Comedian Lily Tomlin: "nope not covered. we consider that an elective procedure - meaning we elect not to pay for it. Remember your health is our business, not our concern."

Hi jomar. I cry when she does the nerve glides. It kills. However it got all the feeling going in my fingers. I have arterial. I had no blood flow to my hand. Because of the torturous pt I have improved a lot although not normal. Normal enough not to have surgery according to my docs at yale and dr Donahue. They wanted to do surgery but the pt has really helped. It costs 400 a session though.

wow 400 per session.

[My plan covers unlimited pt visits if it can be shown to be medically necessary.]
What if Dr D or one of the other highly ranked drs wrote a letter that this is an ongoing therapy in your case.

Have you contacted any of them asking for help to appeal the denial - I know my dad had a Rx denial and his doctor wrote a letter stating that the generic did not help in this case and the brand name was needed, so they approved the brand name rx.

Often the drs or staff know how to word things to get the approvals.
Who wrote the PT rx for you, that might be the one to check with first.