The Cost of Physical Therapy

[icedtea]

I have a herniated disc in my neck, which I first got treated last Sept. Following a steroid shot and an MRI, the doctor ordered physical therapy. I had 4 visits with a therapist in my area. The first was a consultation. The next 3 were all exercises. Pretty much the same ones each time for about 45min, with some supervision from the PT during about 10min of the time. The PT had other patients come in every 15min so it was pretty crowded.

I finally received the bill. My insurance covers a portion of the contracted rate, and I'm responsible for 20% of it. I owe $240 for the 4 visits.

Is this reasonable? How much have you paid for PT?

They're charging me for 2 codes - 'manual therapy' and 'physical therapy exercises.' I've already left a message with the provider to discuss the 'manual therapy' charge. I did some reading online and I don't believe I received this type of therapy. There was no kneading or manipulation of my muscles at all. I only recall the trainer moving my head in different directions for about 15sec and asking 'Does this hurt?'

If there are any physical therapists on the forum, I'd love to hear from you.

Iced Tea

[johnep]

I have had PT numerous times for back, shoulder and other issues. It is always helpful but I want them to show me the best exercises for me and make sure that I do them correctly. Once that is done, should be no more than 3 to 4 visits, you should be on your own to do exercises at home. However, most therapists see us as an annuity, continued visits and payments. My co-pay for these visits was usually $20 to $25 a visit. $60 sounds high unless you are dealing with your annual deductible which you must pay before insurance kicks in. It really depends upon your insurance plan. Best wishes

[Snow Boarder]

I want them to show me the best exercises for me and make sure that I do them correctly. Once that is done, should be no more than 3 to 4 visits, you should be on your own to do exercises at home. However, most therapists see us as an annuity, continued visits and payments.

I too have had alot of PT (wrist/ankle/knee/back). If you are assertive you can do this on your own. Get from them a written home exercise plan (HEP). Join a gym and get on a schedule. Be dilligent and do the exercises and invest the monet saved on copayments.

[icedtea]

I have had PT numerous times for back, shoulder and other issues. It is always helpful but I want them to show me the best exercises for me and make sure that I do them correctly. Once that is done, should be no more than 3 to 4 visits, you should be on your own to do exercises at home. However, most therapists see us as an annuity, continued visits and payments. My co-pay for these visits was usually $20 to $25 a visit. $60 sounds high unless you are dealing with your annual deductible which you must pay before insurance kicks in. It really depends upon your insurance plan. Best wishes

I have a deductible but I'd already met it long before my visits. This is just the coinsurance. I think I'm getting a bad deal but as usual, the patient has little recourse.

[johnep]

Is the bill for more than copays? Normally that is all patient pays. I have never heard of copay being that high. I would have them explain charges. Is the PT practice in your plan or possibly out of your plan?

[icedtea]

Is the bill for more than copays? Normally that is all patient pays. I have never heard of copay being that high. I would have them explain charges. Is the PT practice in your plan or possibly out of your plan?

I don't have a copay with my plan. once i meet my deductible, i just pay a coinsurance of 20% of the contracted rate of the service. The PT practice is in-network. I spoke with them and the insurance and it sounds like I'm out of luck.

[btenny]

I have had PT on my arm/elbow twice over the years. Both times I went to PT for 5 weeks or so. During each visit I got massage therepy and electrical stimulas therapy and then exercise therepy and a special cold bath at the end. Some times I did not get much massage but every time I was charged 20% for my part of the full massage fee. I was also charged for the 20% of the other treatments. It was around $50 or so per treatment for 2-3 times per week, a lot of money for the small amount of stuff provided but necessary as I had bad breaks both times. After the 5 weeks I did home exercises for several weeks and it worked out fine.

But now it is funny when my wife goes to see the same Doctor and I find the entire orthopedic practice is being run and managed by the former PT manager. Now all the ortho Doctors work for him and he also runs 2-3 additional PT offices as well. I guess he was the better business man.

Bill

[bottomfisher]

I don't have a copay with my plan. once i meet my deductible, i just pay a coinsurance of 20% of the contracted rate of the service. The PT practice is in-network. I spoke with them and the insurance and it sounds like I'm out of luck.

$240 co-pay seems expensive for 4 sessions of PT considering its only 20% of the charges. But if its in-network then that is the price your insurer contracted with that facility. Not much you can do about it at this point. Before you give up entirely... here's a couple of considerations. Clarify whether the manual therapy was performed by a qualified person. This should only be a physical therapist or physical therapy assistant. Otherwise, if someone else performed it (athletic trainer), its not billable.

Also there is typically a minimal amount of time that a unit of therapy (manual therapy or therapeutic exercises) must be performed in order to be billed. Typically at least 8 minutes. So even if a qualified professional (PT or PTA) only performed "15 seconds...moving my head in different directions " then that's not billable as a unit of physical therapy. But there are other things they may have done that could also be considered "manual therapy" that were not obvious to you. But just clarify exactly what they were.

Also your therapy should have been primarily one on one. If it was one person overseeing many other patient's at the same, then that may also be questioned as a valid charges.

The above considerations are typical Medicare rules covering outpatient physical therapy services. You likely went through your private insurance and not Medicare. However, most private insurance contracts are similiar to Medicare rules but you would need to see the details to determine if these considerations are applicable.

[icedtea]

I don't have a copay with my plan. once i meet my deductible, i just pay a coinsurance of 20% of the contracted rate of the service. The PT practice is in-network. I spoke with them and the insurance and it sounds like I'm out of luck.

$240 co-pay seems expensive for 4 sessions of PT considering its only 20% of the charges. But if its in-network then that is the price your insurer contracted with that facility. Not much you can do about it at this point. Before you give up entirely... here's a couple of considerations. Clarify whether the manual therapy was performed by a qualified person. This should only be a physical therapist or physical therapy assistant. Otherwise, if someone else performed it (athletic trainer), its not billable.

Also there is typically a minimal amount of time that a unit of therapy (manual therapy or therapeutic exercises) must be performed in order to be billed. Typically at least 8 minutes. So even if a qualified professional (PT or PTA) only performed "15 seconds...moving my head in different directions " then that's not billable as a unit of physical therapy. But there are other things they may have done that could also be considered "manual therapy" that were not obvious to you. But just clarify exactly what they were.

Also your therapy should have been primarily one on one. If it was one person overseeing many other patient's at the same, then that may also be questioned as a valid charges.

The above considerations are typical Medicare rules covering outpatient physical therapy services. You likely went through your private insurance and not Medicare. However, most private insurance contracts are similiar to Medicare rules but you would need to see the details to determine if these considerations are applicable.

I spoke with the PT - she's a qualified professional PT - and she referenced her notebook, which says she performed manual therapy on me. There was no mention of the 8min rule, but all I know is it seems like if I were to file an appeal, it's my word against theirs, and I'm likely to lose. Can you point me to any resources that mention these requirements?

I'm in NY and I wonder if the contracted rate is just really high all over the city. That could be the case. The insurance company - AETNA - wouldn't give me a range.

[bottomfisher]

I spoke with the PT - she's a qualified professional PT - and she referenced her notebook, which says she performed manual therapy on me. There was no mention of the 8min rule, but all I know is it seems like if I were to file an appeal, it's my word against theirs, and I'm likely to lose. Can you point me to any resources that mention these requirements?

I'm in NY and I wonder if the contracted rate is just really high all over the city. That could be the case. The insurance company - AETNA - wouldn't give me a range

Living in NYC explains the relatively high charges. Insurance companies and Medicare naturally reimburse better in areas with higher costs of living. But here's 2 Medicare links I Googled that may provide further insight or just thoroughly confuse. The codes you likely had performed were 97001 - initial evaluation, 97110 - therapeutic services, 97140 - manual therapy. Hope that helps

http://www.cms.gov/Outreach-and-Educati ... 903663.pdf

http://www.medpac.gov/documents/Dec05_M ... cs_OPT.pdf

Addendum: its again important to note that these are Medicare guidelines. Your insurance company's contract with this facility may or may not differ.

[stlutz]

PT doesn't cost the same at all facilities either--it always depends on the negotiated rate.. Rates for me have varied between $85 for a 30 minute session to $250.

A good PT can really help you out a lot--even if it seems like you're doing a lot of stupid exercises. If you were happy with the result, then it was money well spent; if not, then you should see somebody else.

One other note--it's always fair to ask what the rate would be for your insurance before your first visit. Especially for people with high-deductible health plans, it always pays to ask.

[icedtea]

PT doesn't cost the same at all facilities either--it always depends on the negotiated rate.. Rates for me have varied between $85 for a 30 minute session to $250.

A good PT can really help you out a lot--even if it seems like you're doing a lot of stupid exercises. If you were happy with the result, then it was money well spent; if not, then you should see somebody else.

One other note--it's always fair to ask what the rate would be for your insurance before your first visit. Especially for people with high-deductible health plans, it always pays to ask.

Yeah I always try to get those figures from my insurance carrier. I asked a couple PT providers for procedural codes so I could check with insurance for the contracted rates but both said they wouldn't be able to know which codes were relevant until I was seen by the trainer. They also said that depending on my progress, I might be prescribed other treatments, which would mean other codes.

It's like eating at a restaurant where everything says Market Price, and the waiter tells you they won't know the MP until they bring the bill.

I'm still doing the exercises and I've been feeling good, so I guess I'll look on the bright side.

[celia]

Like all medical procedures, you should first understand your insurance coverage. The insurance will usually pay differently if you go to a provider who has contracted with the insurance company (leaving less out-of pocket expense for you) than once who is not contracted. After your deductible is met, you then pay a certain percent of the agreed on charges (agreed between the insurance and provider).

I've gone to a network PT and the first thing the insurance company does when it gets the bill is reduce the fees to what they have agreed on. PT always bills for "cool-down" with ice packs, but that's not an agreed-on expense, so neither the insurance nor I have to pay for that. Then I pay the agreed-on expenses until I meet the deductible for the year. After that, I pay a percent of the agreed-on expenses while the insurance pays the balance.

In January, we started over. PT always gets the same amount of money regardless if I'm there 1/2 hr or 2 hours (as time goes on, more exercises are added, which makes the session longer). The money starts out coming from me, then after the deductible is met, the insurance company pays most, but I pay some. If I ever max out the maximum out-of-pocket amount for the year, then the insurance company would pay all of it.

I suggest you call your insurance company to see if you understand your coverage.

[icedtea]

Like all medical procedures, you should first understand your insurance coverage. The insurance will usually pay differently if you go to a provider who has contracted with the insurance company (leaving less out-of pocket expense for you) than once who is not contracted. After your deductible is met, you then pay a certain percent of the agreed on charges (agreed between the insurance and provider).

I've gone to a network PT and the first thing the insurance company does when it gets the bill is reduce the fees to what they have agreed on. PT always bills for "cool-down" with ice packs, but that's not an agreed-on expense, so neither the insurance nor I have to pay for that. Then I pay the agreed-on expenses until I meet the deductible for the year. After that, I pay a percent of the agreed-on expenses while the insurance pays the balance.

In January, we started over. PT always gets the same amount of money regardless if I'm there 1/2 hr or 2 hours (as time goes on, more exercises are added, which makes the session longer). The money starts out coming from me, then after the deductible is met, the insurance company pays most, but I pay some. If I ever max out the maximum out-of-pocket amount for the year, then the insurance company would pay all of it.

I suggest you call your insurance company to see if you understand your coverage.

I understand my coverage. I have a $500 deductible and after that I pay 20% coinsurance of the contracted rate. I'd met my deductible prior to my PT visits. The charges are for my 20% coinsurance.

[Mudpuppy]

Yeah I always try to get those figures from my insurance carrier. I asked a couple PT providers for procedural codes so I could check with insurance for the contracted rates but both said they wouldn't be able to know which codes were relevant until I was seen by the trainer. They also said that depending on my progress, I might be prescribed other treatments, which would mean other codes.

Your problem was asking for procedure codes. That's way too specific to be given over the phone without at least a consultation and evaluation. If you want information over the phone without going in, a better approach is to ask what a typical range of charges are for that sort of injury, broken down by general categories of PT such as exercises, manual manipulation, etc. Or ask how much an evaluation appointment would cost and then insist on specific cost estimates at the end of the evaluation. But it's not like a restaurant. They don't have a menu because each "meal" is made-to-order for each client.

[pennstater2005]

I have a herniated disc in my neck, which I first got treated last Sept. Following a steroid shot and an MRI, the doctor ordered physical therapy. I had 4 visits with a therapist in my area. The first was a consultation. The next 3 were all exercises. Pretty much the same ones each time for about 45min, with some supervision from the PT during about 10min of the time. The PT had other patients come in every 15min so it was pretty crowded.

I finally received the bill. My insurance covers a portion of the contracted rate, and I'm responsible for 20% of it. I owe $240 for the 4 visits.

Is this reasonable? How much have you paid for PT?

They're charging me for 2 codes - 'manual therapy' and 'physical therapy exercises.' I've already left a message with the provider to discuss the 'manual therapy' charge. I did some reading online and I don't believe I received this type of therapy. There was no kneading or manipulation of my muscles at all. I only recall the trainer moving my head in different directions for about 15sec and asking 'Does this hurt?'

If there are any physical therapists on the forum, I'd love to hear from you.

Iced Tea

Hi Iced Tea

I am a Physical Therapist Assistant. If the PT only did manual for 15 seconds as you indicate then it would not be billable. There is an 8 minute minimum, set by Medicare, that is followed generally by all insurance types. You may have trouble fighting this but it may be worth pursuing if you are willing to confront the PT in question. I would also contact your insurance company and file a complaint. And it also sounds like the PT clinic you were attending was not providing the best one on one physical therapy. Not all physical therapy is equal in quality of care. I would call around to several clinics next time you need therapy and ask if they provided one on one. The clinic I work in is 1:1 for approximately one hour. It is not the best financially but it is the best for our patients and we get lots of referrals through our patients. Also, if your MD recommends you a PT place to go to, it is exactly that a recommendation and nothing else. You are not required to go there no matter what he/she may say.

[jimkinny]

I have had PT numerous times for back, shoulder and other issues. It is always helpful but I want them to show me the best exercises for me and make sure that I do them correctly. Once that is done, should be no more than 3 to 4 visits, you should be on your own to do exercises at home. However, most therapists see us as an annuity, continued visits and payments. My co-pay for these visits was usually $20 to $25 a visit. $60 sounds high unless you are dealing with your annual deductible which you must pay before insurance kicks in. It really depends upon your insurance plan. Best wishes

Yes, I agree that a few visits should get you the knowledge that you need to do the exercises correctly, then a follow up several weeks later.

Of course, many people are unmotivated to exercise on their own and they need the actual office visit in order to do anything. The doc also will know the patient has attended the sessions and the therapist will report in writing the results and evaluation.

I have thought that the number of sessions were excessive for back issues and a total knee replacement. I do appreciate the knowledge that a therapist with a master's degree has and do not begrudge the cost, which can be quite high.

jim

[EmergDoc]

Write the check and count your blessings. It would cost that much labor to do a minor repair on your car. If you don't like shelling out for health care at the time of the visit shell out for an insurance policy with lower co-insurance.