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 Advocacy •
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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.
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