Patient’s Rights (or lack thereof)……….AKA You guys need to get mad and do something!

Medical CartoonSo there has been a good deal of underground rumbling going on in the PT world this week. Because I like to be well informed (i.e. I’m a nerd), I participate in all sorts of social media to stay on top of things. Using Facebook, Twitter and LinkedIn allow me to “talk” with people all over the world and hear about trends. The trend I am paying attention to this week is that PT’s in private practice are mad! And you, the consumer/patient, should be mad too! Why should you be mad? Because no one fully explains your rights to you as a patient, and things are going on that affect you, and you have no idea about it!

The issues that affect you and your ability to access the health insurance you pay for every month include the following:
1) You have a choice of where you want to receive physical therapy. Your doctor can make a recommendation, but cannot require you to go to a specific PT clinic (especially one that he/she owns). This is actually illegal; but, it happens all the time. If I had a dollar for every time a patient told me, “I had no idea I could go somewhere else” I would be a rich woman. When your doctor recommends physical therapy (or when you ask your doctor for a physical therapy referral, which is also your right as a patient), they can give you a list of options for your care. They can also mention that they have a physician owned physical therapy clinic (POPTS) next door or across town, but they cannot require you to receive your therapy there.

2) If you want to see a therapist who does not participate with insurance companies, call your insurance company or go online to find out if you have out of network physical therapy benefits and what they are. If you have an HMO or Kaiser, you may have no out of network benefits; but, most insurance companies do cover a certain percentage of your care even if you go out of network. Then find out what your in network benefits are: Do you have a copay? Deductible? Coinsurance? Limited number of PT visits per year, or per condition, or per lifetime? Even though you have to pay at time of service in a practice like mine, you may come out ahead in the long run. You have to factor in things such as: I see you one on one for an hour, whereas most in network providers see you for 20-30 minutes tops. Additionally, when you come to a PT clinic that is not insurance based, you will most likely see the same therapist every time which helps you maximize your time with the therapist instead of wasting the first 10 minutes of each session retelling your story. Your care at a clinic like mine is only provided by a Licensed Physical Therapist (not a tech or aide) which leads to better demonstration and cuing for corrective exercises. You may only need to come to PT 1-2 times a week as long as you are making the effort to put into practice what you are taught to do. I don’t make patients come in to the clinic to do mindless repetitions of exercises; it’s a waste of time and money. Because of the above advantages, you will most likely improve faster, requiring less visits to physical therapy overall. When you add up the overall cost of your copays/coinsurance for PT 2-3 times a week for 8 weeks versus paying upfront and getting reimbursed at 80% for 1-2 visits a week for 4 weeks, you may find that you come out ahead, in more ways than one, when you go out of network.

3) A current issue that is really a hot topic for PT’s in multiple states (including Virginia) is that we are fighting for Direct Access to physical therapy. Currently, if you want to see a physical therapist in Virginia because you strained your back over the weekend, you are required to get a prescription for physical therapy from your physician (within 14 days, as long as the therapist you are seeing is certified by the state for direct access for 14 days). That’s right, you have to go see your physician for him to take a quick look at you, maybe order some x-rays, and then tell you what you already know – that you need physical therapy for your back strain. How is that cost or time effective? When we get Unrestricted Direct Access in Virginia, you will be able to see a physical therapist first, then be referred to your physician for further work up if it is evident that you need it. If not, you continue your therapy. PT’s have been fighting for this for years in Virginia and the only reason we don’t have it is because the physicians have more money to throw at Capitol Hill to lobby that patients need to be protected from direct access to physical therapy. Huh? Yup, it’s true. That’s what they have convinced the government. In my opinion, this isn’t going to change until the patients themselves get mad and demand that they be allowed to access their health insurance benefits with the provider of their choice.

4) If you have Medicare, you should be triple mad to hear this: You are forbidden by the government from going to see the physical therapist of your choice if they do not accept Medicare. Because my company does not participate with any health insurance, including Medicare, I am not legally allowed to treat Medicare patients in physical therapy. I can see them for “wellness” visits, but I cannot use my knowledge of physical therapy to treat any specific injury on a Medicare patient. Ever. And, the government has made it impossible to challenge this because the current wording of the law is that “physical therapists may not opt-out of Medicare.” So, you either participate with Medicare, and are limited in what you can do and how long you can do it while treating patients, or they exclude you entirely for caring for an entire (growing) segment of the population. Again, the only way I see to change this is for thousands of Medicare age folks to get really mad and tell the government that they worked plenty hard to save up their money and they have educated themselves to find the best provider for their injury, and they will NOT be told that they can’t pay out of pocket to see that physical therapist.

Are you mad yet? Good, now go call your people and march on Capitol Hill or something like that!

Have a great weekend everyone!

  1. Your last statement “You are forbidden by the government from going to see the physical therapist of your choice if they do not accept Medicare. Because my company does not participate with any health insurance, including Medicare, I am not legally allowed to treat Medicare patients in physical therapy” is not quite the same for physicians. If you are opted out of Medicare/Medicaid then you are not allowed to BILL Medicare. However, you can still see Medicare/Medicaid patients if they sign a waiver that basically says “you can’t submit to Medicare/Medicaid for payment. We see a number of these patients every day. The ones that value a real MD, great access, great care (as you point out so well in your article) gladly pay a reasonable, transparent fee based on time spent. Not all patients want this, but, when did we evolve to a single model of “on size fits all” care? Could you imagine what a single, government approved car, or clothing, house, resteraunt , etc. Would be? NOBODY would be happy. Please feel free to contact me if you’d like to see our forms etc. GREAT ARTICLE!

  2. Hi Jack,
    Thanks for commenting, I’m glad you liked the article. You are absolutely correct in what you are saying: physicians can opt-out of Medicare and go into a private contract for upfront payment from Medicare patients.
    Physical Therapists, however, can NOT opt-out of Medicare to go into a private contract with a Medicare patient. The way the Code is written, the only 2 healthcare professionals that cannot opt-out are Physical Therapists (as it is worded, that is because we are “not practitioners”) and Chiropractors (because as it is worded, they are not “physicians”).
    Al other healthcare providers, MD’s, Podiatrists, Nutritionists, Nurse Practitioners, can opt-out.
    This, along with not having unrestricted Direct Access to physical therapy in every state are the two biggest issues affecting patients when it comes to physical therapy.
    I am working with others to get this to change.

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