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What Can You Do to Improve Your Physical Therapy Coverage?

Talk with your employer/benefits manager. The employers who contract and pay for employee health care plans often have the most influence with insurers. Employers are interested in keeping their employees on the job and their premiums low, so providers who can help employees prevent injuries and avoid recurrence (as well as promote a healthy lifestyle) have particular appeal to them. Arrange a meeting with your human resources director or whoever is responsible for negotiating the terms of the company's insurance plan.

Ask your human resources director or insurance company the following questions to determine if your current benefits package gives you access to appropriate physical therapy services:
  1. Is your physical therapy benefit "bundled" with those of other providers of care?Physical therapy services should be listed separately in the benefit language so that access to necessary services is not compromised.
  2. Does the benefit language permit access to physical therapists for each condition during the year?Benefit language should permit treatment of more than one condition in a calendar year (eg, ankle fracture in January and low back injury in July).
  3. Does the benefit language permit access to physical therapists for each episode of care?A person may require more than one episode of care for the same condition. For example, someone with arthritis may receive physical therapy intervention for knee weakness in an attempt to avoid surgery. While this is often successful, some patients may still require surgery for the knee condition (eg, total knee replacement), which may require post-operative physical therapy treatment. The benefit language should support each "episode of care."
  4. Does the benefit language ensure coverage that facilitates restoration of function?Benefit language that restricts physical therapy care to a 60- or 90-day period imposes an arbitrary limit on recovery. In determining an appropriate physical therapy benefit that will allow an individual to return to his or her previous level of function, benefit language should reflect the normal amount of time that it takes to recover from an injury or from surgery.
  5. Does the benefit language ensure coverage that promotes functional independence for those with chronic conditions?Someone who has a chronic condition may need to be seen periodically by a physical therapist. The physical therapist will determine if the individual's home program, equipment, or adaptive devices should be modified. (For instance, children requiring orthotic devices will need modifications to those devices as they grow.) Benefit language should ensure that someone with a chronic condition may receive the kind of care that promotes personal safety and the greatest degree of function possible.
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