A Supportive Medical Team is Apparently a Luxury Item Not Covered by Health Insurance

By: Loolwa Khazzoom, Founder, Dancing with Pain

October 21st, 2009 • Patient AdvocacyPrint Print

Somewhere in the process of negotiating a holistic approach to physical therapy that would be covered by my health insurance, Joanie (the physical therapist I stayed in the USA to work with) decided to stop playing on my team and go to bat for the health insurance company:

Whereas she initially confided in me that interns with no medical training were responsible for approving or denying my doctor referrals for physical therapy (indicating that she thought the system was absurd), and whereas she initially promised to help me get the treatment I so desperately needed, she suddenly did an about-face – claiming that I was “committing fraud” by arranging a holistic approach to my physical therapy, and saying that she would not go along with it.

“This is a hospital,” she practically yelled at me in a shocking phone conversation. “We only treat people with acute conditions.” Um, not so much. I distinctly recall a conversation with a medical group representative, where I was advised to go to Joanie’s center specifically because it was a community rehabilitation center not tied to the hospital, not treating only acute conditions. The center’s title, in fact, was “[Medical Group] Outpatient Physical Rehabilitation” (emphasis added).

I turned to my doctor, seeking help. On the one hand, she was supportive. “I’ll ‘commit fraud,’” she said, shrugging her shoulders, clearly of the mind that the assertion was preposterous. On the other hand, she wasn’t so supportive: “Why do you need to keep going back for sessions?” she asked. “They have already given you exercises.”

“Well,” I replied, “my body changes from week to week as I progress. I need someone monitoring me. I can’t just keep doing the same exercises forever. As I get better, I need different exercises.” (Um, why exactly do I need to explain this to a doctor?)

As we continued talking, I also shared with my doctor how critical it had been to my rehabilitation to have a place to go for coaching, guidance, and encouragement — a place where people finally cared and supported my healing, instead of fighting it. “I think that’s what the insurance company has a problem with,” Nina responded. “They don’t want to pay for a cheerleader.”

A cheerleader? A competent and caring physical therapist is a far cry from a cheerleader. But hell, if a cheerleader is what it takes to get someone back in the game, then pay for a fucking cheerleader. For chrissakes, I mean, what the hell is wrong with our healthcare that 1) it takes forever to find someone who cares and 2) when you find that person, s/he is considered a luxury item outside the purview of medical coverage.



Comments

Florence Mathieu-Conner October 23rd, 2009

Hello Loolwa,

I am currently helping a British lady moving to Tel Aviv to find an doctor specializing in treating chronic pain. Could you make any recommendations for her? You can email them to me and I will pass them along to her. Thanks a lot for your time, and I hope you feel better every day!

Florence

Sara Firman October 26th, 2009

Loolwa – I have just been led to your blog via your excellent AARP article.  I want you to know that I have subscribed and will read more.  Your story is important and shocking.
Next month I shall be speaking at a Conference in Chicago to physical therapists who work in the water.  I myself am an practitioner of alternative aquatic therapy.
I want to share with these clinicians the aspects of  ‘alternatives’ that science (and insurance) are leaving out of their service to people in need, to the people they serve.
Your story adds another piece for me.  I will do what I can in my own arena to help.  So glad to discover you.  So deeply sorry to hear of all you have had to face and continue to face.
With respect and care, Sara

Tracey @ I'm Not Superhuman October 26th, 2009

Wow, I feel like you’re living my life! I have chronic knee pain, and during the summer of 2008 my doctor set me up with a fantastic physical therapist. Things were going great, my knee pain was lessening thanks to the strengthening my physical therapist was doing. Each visit she would check my knees again to see if and how they were improving. She’d use a cold laser to tackle inflammation. And she’d modify my exercises depending on how my knees were feeling that day. As my strength increased, she’d add a new exercise or modify an old one. I really, really was improving.
 
But every month I was required to fill out a progress report for the insurance company. It would ask ridiculous things like, Rate your pain from 0 to 10. As if I know the difference between a 6 and 7. After 32 sessions, my insurance said I was cut off. But my plan (which, by the way, I pay for each month out of my pay check, thank you very much!) allots 60 physical therapy visits per year. I was only at the halfway point.
 
My physical therapist sent in a request for me to continue treatment, and asked me to fib on the progress report. (Just put a 4, she said, because it’ll look like you’re healing faster.) After a lot of back and forth, I was rejected. According to some man in some desk in some town far, far away, I wasn’t healing fast enough. (As if I didn’t already know that! I’m the one dealing with the pain after all!!) My physical therapist petitioned them again with not luck. My doctor said he couldn’t do anything since they don’t take a doctor’s opinion into account on recovery matters.
 
Needless to say, the whole process was infuriating. My doctor and physical therapist—both of whom had seen me and  examined me—understood the physical therapy was helping, if slowly. But, as my physical therapist said, my condition isn’t something that will just heal overnight. Even so, none of that matters. What matters is that my stupid progress reports didn’t note change fast enough.
 
I’m sorry you’re going through this too. Now I try to keep up on my PT as much as possible (I had to join a gym to have all of the equipment I need, and even now I still can’t do certain exercises) but don’t have someone adjusting PT as needed.

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