Know Your Rights-How to challenge your insurance for more visits.
Many times certain insurance companies will approve a number of physical therapy visits for your care. Unfortunately, in our experience, this is never as many visits as your physical therapist requests. The number of visits awarded many times are not in the patient’s best interest, do not consider the physical therapist’s expertise or recommendations, and do not seem to be based off of evidence based practices. This could lead you to be in a position where you need more physical therapy visits to be covered in order for an optimal outcome.
Typically the process goes something like this:The Physical Therapist requests visits based off of clinical findings from the evaluation. The insurance company gives a certain number of visits. When these visits are used the PT will request more visits. At some point the insurance company will likely deny any future visits. With your consent we will appeal for more visits to the insurance company (this is called an internal review). At this point the insurance company may approve or deny future visits. If they deny and we both agree that you still need additional visits you can request an external review that are independent from the insurer. In the past, this could have cost the patient $25 but under the new healthcare reform it is now waived. These requests are part of your rights as patients and if you need more visits please let us help you.
Talk to your friendly Atlas Physical Therapist if you have questions regarding your insurance coverage!