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Physical Therapy + HMO Lifetime Restrictions = 60 days MAX?

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Old 03-02-2003, 03:32 PM   #1
Join Date: Dec 2002
Location: Nashua, NH
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Post Physical Therapy + HMO Lifetime Restrictions = 60 days MAX?

Are any of you aware of this, or do you know of this as well? (I'm trying to assess if this is an individual thing, related to particular companies, HMO's in general, etc.)

Physical Therapy has a lifetime max of 60 days? Meaning, regardless of how many times per week the doc prescribes, regardless of for how many weeks therapy goes on, and regardless of whether or not you get "cured" ... there is a LIFETIME 60 day cap on your access to physical therapy?

So if I get PT for my shoulder, I'm re-evaluated in 30 days, I'm prescribed another 4 weeks of therapy, and if at that re-assessment I am not better, it's too bad and everything comes out of pocket? (This is how the PT explained it btw, NOT how the insurance company explained it)

HOW do they justify this kind of treatment, and what are we supposed to do about it? What do we do as patients who are not healed? What can we do to get better, and how is it that they have the rights to dictate this type of inadequate care, and how do they get away with this?

Personally, my totally unprofessional opinion is that this is the equivalent of providing substandard care, even negligence. Are there ways we can oppose this type of treatment and regulation, and what logistically, can we do?

The strangest thing is --- so now what happens if after 60 days of maxing out the "lifetime limits" of physical therapy entirely, what happens if, while I'm still not better, my unhealed condition results in some type of accident, what if I hurt my self (if I slipped or dropped something) or it results in injury to another (same reason), or results in compensatory injuries in adjacent areas of my body?

This is a sincere inquiry, and I'm most interested in hearing any replies or other's experiences.

Thank you!

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Old 03-02-2003, 11:01 PM   #2
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My understanding is it is 60 days max (mine is per year) for each reason PT is prescribed. If I am in an accident and my arm is injured, I get 60 days covered for the PT, maximum. This can be appealed, and the insurance may or may not accept it. If a problem reoccurs and a doctor prescribes further PT, it may be covered.

Insurance is a help, but the contract may not necessarily provide complete coverage. We have to read it when we accept it and see if it covers what we want it to cover. We can always refuse coverage we think is inadequate.

Every contract has its limitations. Some people end up on public aid, due to selling everything for medical costs.

As for your coverage, you need to call your insurance company and have them explain their policy. We would be just guessing.

[This message has been edited by friend (edited 03-03-2003).]

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