Seeing two physical therapists at once - is it OK?

January 31, 2015 12:33 AM

I've been seeing a PT for 3 months who is covered entirely by insurance. They provide ultrasound, etc., but not much else. I want to see another PT to get better treatment and pay out of pocket. Would it be OK to continue seeing the insurance-covered PT for ultrasound and e-stem once a week and pay out of pocket to go to the other PT once a week? Would my insurance company frown on this if they found out?
posted by anonymous to Health & Fitness (8 answers total)

This may be useful. A PT covered by my insurance used only ultrasound and e-stem. After no improvement in 3 weeks, I found a PT with a good reputation and paid out of pocket. The new PT told me ultrasound and e-stem were worthless for my condition. I asked why the first PT would use it, she said I'll bet that's all your insurance covered. She was right. I showed improvements after most sessions with her.
posted by Homer42 at 1:02 AM on January 31, 2015 [2 favorites]

I agree with Homer42. Insurers are horribly restrictive for things like PT, mostly because treatment can be so open-ended and continue for months and months. It really doesn't matter to them if the treatment is successful or not. It's simply about the money spent.

Seeing the second PT would seem to be a much more fruitful move, even though it's out-of-pocket. Make very sure, though, that what you pay to the second PT will, in fact, count toward the out-of-pocket charges on your insurance plan. It would truly suck if they didn't qualify.
posted by Thorzdad at 3:33 AM on January 31, 2015 [1 favorite]

I did this with my daughter and it has worked fine. In her case I put the therapists in touch with each other so they could compare notes and coordinate care but my insurance didn't know or care about the therapy they weren't paying for. The dual therapy worked very well - we saw one in clinic and one in our home, so they could focus on different things. She improved quickly.
posted by peanut_mcgillicuty at 6:32 AM on January 31, 2015 [1 favorite]

Your insurance doesn't care who you pay to do what to you. They only care who you're making THEM pay and therefore THEY control what THEY allow people to do to you. There is no subterfuge here.
posted by zizzle at 6:49 AM on January 31, 2015 [1 favorite]

The insurance company doesn't care what you do with your own money on your own time, as long as you don't wind up trying to make them pay for something they didn't agree to pay for.

That being said it might make sense to figure out how to get them to pay for the treatment that will actually help. For example, perhaps there's another PT who is participating in that insurance and perhaps your doctor can write a prescription for it.
posted by bleep at 11:18 AM on January 31, 2015 [1 favorite]

I totally agree with bleep above. Additionally if the PT has been doing ultrasound and ems for 3 months without making any changes to your care plan then I would question whether or not that PT is actually treating you or just trying to drain your insurance company.

EMS is really good for acute muscular sprains, but isn't going to do much more than provide temporary relief more than a month into a care plan.

Look for a new PT who is in-network.
posted by Broken Ankle at 2:13 PM on January 31, 2015 [1 favorite]

The one thing you should do is make sure both PTs know about each other.

If you're paying out of pocket to the new PT and they're not billing insurance, insurance won't care. But they will definitely not count it towards your deductible or out-of-pocket-max. Ask me how I know.
posted by radioamy at 10:54 PM on January 31, 2015 [1 favorite]

I dumped my HMO-provided physical therapist and have been very happy with the non-insurance-covered PT I've found elsewhere.
posted by Lexica at 7:09 PM on February 1, 2015