My fun light-hearted educational posts have been delayed for a PSA on insurance and "experimental" physical therapy.
I got a call on Friday from my physical therapy office telling me I was out of sessions for my services. I was confused by this, because we had worked out that I could come for as long as medically needed. When I called the insurance company they gave me not 1. Not 2. But 3, different answers.
1. They explained I have this many sessions and the cost is this amount and once you've reached your out of pocket then it's fully covered.
Me: Cool, so my Dr's office was given inaccurate information?
2. No, looks like you can receive up to as many as needed because it's medically necessary.
Me: Cool, so I can reschedule my appointment for this week because I'm medically needing this treatment.
3. No looks like you're type of physical therapy is experimental.
Me:
Confused?
Yeah me too.
Imagine: trying to figure out what is being said, while being in a blind rage, while bawling your eyes out, while trying to get your work newsletter out and you have me on a Friday afternoon with insurance 'professionals' trying to explain to me why my form of physical therapy is experimental.
I have a few issues with what is going on with my insurance 'provider'
1. I have been going to physical therapy for 8 months now.
8 (clap) months (clap).
And the insurance company is just now letting my physical therapist know that my claims are denied?? I will say I have been proud of how on top I have been checking claims, questioning weird issues that pop up. Pretty sure if I saw 8 denied claims that would have been a red flag for me.
2. I have done a lot more self healing on myself that could be considered 'experimental'
reiki, yoga, meditation, crystals, praying, crying hysterically on the floor.
I know we're not in a society where yoga, reiki and meditation are considered medical practices. HOWEVER, physical therapy is. Many people have it done and many people have found huge success with it.
What makes me even more upset:
It's not the physical therapy that's getting questioned, it's the type. Which led me down to meltdown number 2 of the day. Oh really, my pelvic floor physical therapy is experimental? Why is my form of physical therapy experimental, what makes it any different than a knee replacement physical therapy, or a work related back injury? If I had a male condition, would it be covered? (Probably).
3. I could go to to my doctor right now and get covered for pain meds. We claim we are in an opiod crisis. Well, yeah...my natural form of healing isn't covered but you'll put me into early menopause to try, I emphasize the word try, to slow the endometriosis down. There's a 'new med' that was pushed on me that I would consider an experimental drug called Orlissa that does just that, you may have seen commercials for it. It is the typical you may experience, heart failure, kidney malfunction, liver stoppage, or even death commercials.
I will remind everyone, I have not taken one pain medication consciously this whole journey. Not. One. (the only ones I have taken are the ones they forced on me while unconscious in the hospital, another topic for another post). I made the choice to not, I know it's not for everyone, but I knew the consequences if I did get hooked on these. I chose a healing plan that was right for me that was medically recommended and now I can't even do that. I knew that I would be fighting this illness until my magical menopause years, but I didn't think I was going to have to fight for my right to treatment.
If anyone has any suggestions or tips on how to fight the insurance and medical coding system please let me know.
I will be getting into the medical billing issues later, but for now, I just need to be able to get back into physical therapy!
When Life Gives you Endo....you have to fight like hell to get what is right for you.
No comments