Medicare Cap on Physical Therapy

insurance0707

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I had a client call me the other day. She's getting physcial therapy. On the bill, it listed that she had met $800 of her $1860 cap that Medicare has put on physical therapy. I had never heard of a cap being placed on physcial therapy for Medicare patients. I went online and sure enough, January 1st 2010 there is one. Here's the article.......

Physical therapy patients face possible cuts in Medicare aid - KansasCity.com

She was a bit upset because she has a few more months of therapy and she will meet the cap before therapy is over
 
This is nothing new. The cap has been in force, removed, and put back for several years.

Wonder what Obama would have to say about a limit on coverage from a private, I mean public health plan.

Rick
 
With the reimbursements being cut that $1860 should go further than ever before! Way to go congress!
 
I had a client call me the other day. She's getting physcial therapy. On the bill, it listed that she had met $800 of her $1860 cap that Medicare has put on physical therapy. I had never heard of a cap being placed on physcial therapy for Medicare patients. I went online and sure enough, January 1st 2010 there is one. Here's the article.......

Physical therapy patients face possible cuts in Medicare aid - KansasCity.com

She was a bit upset because she has a few more months of therapy and she will meet the cap before therapy is over

The problem for those over 65, is that individual major medical is unavailable... and Med Supps will not cover Non-Medicare claims. Furthermore, many of those over 65 are being forced out of work, and without retiree group insurance they're stuck.

Is this a call for Supplemental (Limited benefiet) policies?

Who knows of a Limited benefit plan that covers outpatient therapy? And would it pay enough to cover these claims cost effectively? And of course... not exclude pre-ex....???

I doubt it. This is a crack built into Medicare you can't get out of. Because Medicare is available to virtually EVERYONE that reaches 65, insurance carriers usually won't pay those claims because it is assumed that taxpayers will cover the cost. If you are still working for a small employer (under 20 employees) the law requires Medicare to be primary coverage, but if you work for a larger employer you might get coverage... and if you retire, Medicare becomes primary, so you are back in the crack. You can't get away from it.
 
It looks like they could go into the hospital and get the therapy...I don't know if they would have to be inpatient or not. It looks like the gov is trying to curb the out of control costs on physical therapy
 
It looks like they could go into the hospital and get the therapy...I don't know if they would have to be inpatient or not. It looks like the gov is trying to curb the out of control costs on physical therapy

Yeah, I had a MA client that needed physical therapy for a torn rotator cuff. They charged her $40/visit (Specialist rate) for a physical therapist for about 14 visits... I had the same injury, did my own exercises, paid nothing, and healed in the same amount of time.
 
Yeah, I had a MA client that needed physical therapy for a torn rotator cuff. They charged her $40/visit (Specialist rate) for a physical therapist for about 14 visits... I had the same injury, did my own exercises, paid nothing, and healed in the same amount of time.

That's exactly the point.
 
I had clients that said the samething, They went to the physical therapist and didn't want to keep paying the copays, so they just did the excercises at home. They didn't think they were doing anything that they couldn't do in their own home
 
but exercises at home can harmful for them because physical therapist is very careful and they know to move the body how to do it and some time it can become worst so i suggest must have physical therapist assistance even u r doing exercises at home.......
 
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