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Author Topic: What to do if insurance approval delays continued PT for patellar fracture  (Read 1078 times)

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Offline tilly4

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I just found out that my medical insurance is debating whether to approve PT sessions dating back to June of '09, as well as any future sessions.  I have been making good progress in PT, range of motion now about 106.  My dilemma is that if I continue going, I could owe a great deal of money out of pocket-- I already may owe about $2,000.  It came as quite a surprise to me that insurance needs more information-- especially since my PT sent the information in, but they apparently misplaced it.  If I stop going for a while, will I lose any of the progress I have made?  I would like to believe that I can achieve improved range of motion on my own, but I just can't bend me knee the way the PT does it.  It seems impossible to inflict that much pain on myself.

My injury occurred at the end of January, surgery was on 2/6, and had hardware removed on 7/10.  Any suggestions on what to do?  Do I go into debt because not having PT may mean suffering for the rest of my life?  Or, is it OK to wait and see if insurance will cover the prior sessions and hopefully authorize more sessions, and then resume?  Can I do this on my own?  I am 62 years old, but a very young 62, and I don't want to be more limited than I need to be.  I am already mourning the fact that running and tennis are probably no longer options for me.

Offline Catkaru

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Re: What to do if insurance approval delays continued PT for patellar fracture
« Reply #1 on: September 04, 2009, 04:12:33 PM »
Hi Tilly4,  Welcome to the boards.  The only advice I would offer at this time is to do as much at home as you can until the Insurance comes through with the answer.  Do all the exersizes you do at PT at home.  I had to leave PT because I could not afford the $50 co-pay anymore.  And I had a long way to go.  I used a machine at PT to bend my knee for ROM.  The therapist never touched me.  When I left I was measured at 122.  What I do at home now is lay on my stomach and put a dog leash handle on my foot and pull on it as much as I can stand it and hold for ten.  I do this five times.  Sounds primative I know, but it helps.  Hope things go better for you soon.
Cat
Catkaru

Offline tilly4

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Re: What to do if insurance approval delays continued PT for patellar fracture
« Reply #2 on: February 14, 2010, 10:20:54 PM »
Hi Cat,

I just noticed your reply.  Those are good tips for anyone who has to do it on their own.  I am pretty much recovered.  I was lucky to have a personal trainer at the gym who is very knowledgeable about anatomy and who has helped me a great deal in regaining my strength.  I hope that you are doing much better as well.

tilly4 AKA Liz

Offline dm

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Re: What to do if insurance approval delays continued PT for patellar fracture
« Reply #3 on: February 17, 2010, 05:19:43 AM »
I would ask your therapist if they keep fax confirmations when they send in information on patients, as proof it was sent. If so, I'd ask for a copy of the confirmation to send to the insurance company, since they may have misfiled the faxed information that day. I would ask your therapist to set you up with exercises you can do at home until your insurance issue can be rectified. You have to take into account what your insurance benefit is, the amount of benefit used, the likelihood of benefits being retroactively and future authorized due to medical necessity, etc. Get your OS involved and have him reorder the therapy, back to the date you started, along with diagnosis codes for medical necessity. I'm sure your doc  ought to be able to help straighten out the authorizations, usually they are the one who has to obtain it, in my experience.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.















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