Gotta Love Autocorrect!

Alright, up front I have to say that this was not originally going to be today’s topic……..however, it was so funny and ironic that I had to share.  I was texting a message today and must have started spelling the word “insurance” incorrectly, because all of a sudden the word uninsured popped up and my mind read it as “uninsurance”……..and I laughed out loud at the thought of uninsurance because that’s what most of us have!  We all pay a ridiculous amount of money for “insurance” that often fails when we need it most.  How often have you been forced to either discharge a patient or make them sign a self-pay waiver (Aetna…..25 visits, anyone) because of their insurance? How many patients get upset that their insurance prevents them from seeing the provider they want to see? (Medicare patients, anyone)?  Ever have a patient whose insurance won’t cover an MRI until they have had a trial of physical therapy and failed all conservative treatment? How absurd that our insurance companies are often the ones preventing us from accessing the care we need.

As P.T.’s and also as healthcare consumers/patients, we have to take a stand against this.  This shift is happening slowly, as more patients and therapists get to the end of their rope and abandon traditional insurance based healthcare; but, we are still the minority.

My current beef is with Medicare.  As a P.T., I can never, ever opt-out of Medicare.  Believe me, I checked into it for days to get to the bottom of this.  I was actually told by Highmark, our local Medicare carrier, that as a P.T. I could opt-out, they even directed me to the form I could use. But, after running this by many other therapists, and the APTA, I found out that the advisor from Highmark was completely wrong and was actually advising me to do something illegal!  Only physicians and certain types of “practitioners” can opt out of Medicare (MD’s, nutritionists, and some others), but the law was written in a way that singles out P.T.’s and Chiropractors to say that we are not “physicians” or “practitioners” and therefore don’t qualify for the opt-out procedure.  What?!  Now I’m not even a “practitioner?”

What this means is that as P.T.’s, we cannot ever “opt-out” of being a Medicare provider and therefore we can NEVER accept Medicare patients if we are no longer participating with Medicare.  Doesn’t sound like a big deal, you say?  It is.  Now that I am in private practice again it is a huge deal, because I don’t participate with insurance companies, including Medicare.  All patients pay at time of service; and, since it is illegal to accept any cash from a Medicare patient for treatment, I can never treat a Medicare patient.  This takes away a HUGE patient population – a patient population that is increasing with time, a population of very active seniors that are living longer, and a population (in the D.C. area) of folks who have worked hard all their lives and have the cash to pay out of pocket for quality services (you have never seen anyone get as mad as an active, extremely intelligent Medicare patient who is denied the ability to pay out of pocket with their hard earned money to get the best of the services available in the community!)

Here it is straight from the horse’s mouth: 

40.4 – Definition of Physician/Practitioner

(Rev. 62, Issued: 12-22-06, Effective: 11-13-06, Implementation: 04-02-07)

For purposes of this provision, the term “physician” is limited to doctors of medicine; doctors of osteopathy; doctors of dental surgery or of dental medicine; doctors of podiatric medicine; and doctors of optometry who are legally authorized to practice dentistry, podiatry, optometry, medicine, or surgery by the State in which such function or action is performed; no other physicians may opt out. Also, for purposes of this provision, the term “practitioner” means any of the following to the extent that they are legally authorized to practice by the State and otherwise meet Medicare requirements:

• Physician assistant;

• Nurse practitioner;

• Clinical nurse specialist;

• Certified registered nurse anesthetist;

• Certified nurse midwife;

• Clinical psychologist;

• Clinical social worker;

• Registered dietitian; or

• Nutrition Professional

The opt out law does not define “physician” to include chiropractors; therefore, they may not opt out of Medicare and provide services under private contract. Physical therapists in independent practice and occupational therapists in independent practice cannot opt out because they are not within the opt out law’s definition of either a “physician” or “practitioner”.

Yes, folks, that’s our government protecting the innocent Medicare patients from all of us evil P.T.’s (who aren’t even providers in the first place).  Thank goodness everyone is safe now.  Move along, nothing to see here…..

If it ruffles your feathers that your “uninsurance” is restricting the care you can give and receive, then good!  Now let’s go out there and do something about it!

  1. Hmmm… interesting topic. I’m not quite sure I understand all the details. I can’t believe that the government can prevent private citizens from spending their private dollars on whatever they want. That would be a serious constitutional violation imho. Is it that they can’t get reimbursed from their Medicare insurance if you don’t participate with Medicare?

  2. Hi Ann,
    Jennifer Gamboa, PT in Alexandria, Virginia was doing some legislative work of PT opt-out. You can Google her or get her number from the APTA for more information.

  3. Thanks, Tim. I know that Jennifer is very involved in this type of work. I will get in touch with her.

  4. What is they go beyond cap 3700 and sign a advanced beneficiary notice can they come as cash pay maintainence for PT?

  5. Do you know if a PT has never applied to be a medicare provider, do they still have to fill out papers to opt out?
    I am being told that I need to opt out, even though I never opted in. But you are saying we can’t opt out?
    I got a call from a Medicare patients secondary insurance that says they will pay a portion if I send them my opt put paper. Of which I have no such thing and cant get obviously.

    As well as providing a practice that specializes in OSTEOPATHIC Physical Therapy, I make Custom Orthotics.
    I’ve always assumed that since medicare doesn’t pay for orthotics, that I am ok asking for direct pay for them, correct?
    So should fee for service PT’s just never see Medicare patients to be safe, or is a document signed by them that they agree to that practice and will not bill medicare ok? Sounds like NOT. Just want to clarify.

    Thank you so much Glad I found your posting.

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