Sometimes it is s judgment call about whether the treatment should be done vs watchful waiting. I tend to ask the doc what he would do if it was his or his loved one’s body. That answer tends to be helpful to me.
I broke a bone in my wrist a year ago. 4 weeks in a cast and when it came off MD said give it a week and if you think you need PT call back and request it. I asked how would I know and he said if you can wring a washcloth with both hands, you’re ok. After a week, I could not, so I called and requested PT. No problem, authorized 12 sessions immediately. In Michigan, you must have a dr RX to get PT.
With regard to PT…find out what the cost will be if you pay yourself at each session. Family member here has a $4500 deductible (so $3000 doesn’t sound so high to us). When January 1 came the year she was having PT and was going to need to meet the deductible…again…she asked about out of pocket payment.
They would have billed insurance $250 for a 90 minute session. Out of pocket payment day of session…$50.
Absolutely second thumper. Most PTs I have been to rather deal with Visa than insurance companies.
The only problem with that is you don’t get deductible credit. What they “bill” the insurance company is irrelevant. Their contact will knock it down significantly. They would be hard pressed to give you a better rate than the contract insurance rate.
Is there any way to ask for an out of pocket package price for xx sessions total that would apply vs the deductible amount?
My kid was getting PT once a week…$200 a month out of pocket…and no limit on the number of sessions because she was paying herself. If she had had them submit to insurance, it would have taken 4 months or more to reach the deductible…and by that time…she would have exceeded the number of allowable sessions…
Really…if she had had another significant medical event…the deductible would have been met with THAT…not with the PT sessions.
It’s been a while, but I did PT and had occasion to figure out how the deductible, out of pocket max, copay, and max visits all worked.
Just using made up numbers since I don’t recall the exact details, but I paid full price for the visits until I hit my deductible, say 1k. After that it was a 20% co-pay each visit, until I hit my out of pocket max, say 2k. After 2k (deductible plus copay), my visits would’ve been 100% covered.
However it neatly lined up that the maximum number of annual PT visits, say 30, somehow lined up with my out of pocket max so on my last PT visit I hit the out of pocket max so I never did a 100% covered visit. But of course any other medical stuff would’ve been covered 100% without a copay at that point.
About every 6 weeks I had to call my doc to have him extend/renew the PT prescription.
H’s PT offices (he had PT at different places over the past many years) would regularly call and have H’s PT extended and the MD’s office would call H to come in and see him as needed.
When H reached the max # of PT sessions for the year, his orthopedic surgeon got him some additional free PT because he was still having pain.