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Published October 22, 2011, 11:30 PM

Bursack: Fighting for more physical therapy

Dear Carol: What can you do when an insurance carrier stops covering physical therapy sessions because a patient is not making enough progress?

By: Carol Bradley Bursack, INFORUM

Dear Carol: What can you do when an insurance carrier stops covering physical therapy sessions because a patient is not making enough progress?

My 66-year-old sister suffered a massive stroke and was in physical therapy for several weeks. Because she was not making enough progress in her physical therapy, they discontinued her sessions. The insurance company states that there is no point in continuing the discomfort, effort and expense of physical therapy if it is not helping, but her husband thinks she could benefit from more. – Amelia


Dear Amelia: You sister and her husband should first discuss this with the primary doctor. If physical therapy isn’t helping, what would the doctor suggest?

Could the problem be with the particular therapist’s approach? Physical therapists vary in their approaches just as other medical professionals do. If this doctor is convinced that therapy is no longer going to help, the couple may want to seek a second opinion.

It’s also a good idea to look into the insurance company’s appeal process. Usually that information is included in any correspondence from the insurance company. Sometimes an appeal can get results, especially if the doctor still thinks more therapy may be helpful.

Your sister could also see a doctor who practices integrative medicine, meaning that the doctor is open to both traditional medicine as practiced by most traditional U.S. physicians, and holistic or alternative medicine. Many physicians are becoming more open-minded about alternative approaches, even if their practice is traditional. The reason for this is that studies are showing that there are many documented cases where acupuncture, yoga poses, massage and other approaches used for centuries in eastern cultures have helped patients. Many chiropractors also incorporate alternative therapies such as acupuncture in their practices, and some join forces with massage therapists.

Unfortunately, there are, as in nearly any profession, practitioners who will promise the world. Ask around if you are looking for alternative therapies, and make sure you look for accredited credentials and licensing.

Word of mouth recommendations are good, too. You would want a practitioner who can honestly tell you if there are other therapies that may help your sister – and at what cost. Most health insurance policies don’t cover many of these therapies.

What I’m suggesting is that your sister shouldn’t throw up her hands and say this is as good as it gets. An insurance appeal backed by a medical doctor, or alternative treatments given by a reputable practitioner, could mean a better quality of life for your sister, as well as her husband as a caregiver. If nothing else comes of it, they will know they made the rigorous and clear-eyed effort to do whatever can be done.


Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carol@mindingourelders.com.

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