Physical therapists provide high quality health care that is covered by most health insurance companies. They help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients with injuries or disease. They also restore, maintain, and promote overall fitness and health. The use of physical therapy benefits both the patient and the insurer. What do physical therapists do?

Physical therapists use the following interventions to achieve patient treatment goals:

• Therapeutic exercise (including aerobic conditioning)
• Functional training in self care and home management (including activities of daily living and instrumental activities of daily living)
• Functional training in community or work reintegration (including activities of daily living and instrumental activities of daily living)
• Patient/family education
• Prescription, fabrication, and application of assistive, adaptive, supportive, and protective devices and equipment
• Manual therapy techniques (including joint mobilization and Manipulation)
• Airway clearance techniques
• Physical agents and mechanical and thermal modalities
• Electrotherapeutic modalities
• Wound care

What happens during a visit to a physical therapist?

The physical therapist will evaluate a patient’s condition and then will design and implement a treatment program. The objective of physical therapy is to manage and prevent disability, relieve pain, and restore the patient’s functional ability.

Where do physical therapists practice?

Physical therapists practice in a wide variety of settings, such as acute care and rehabilitation hospitals, outpatient clinics, private practices, sub-acute care and skilled nursing facilities, schools, in the home, corporate or industrial health centers, wellness centers, fitness centers, and long-term care facilities.

When Do Patients Need a Physical Therapist?

The following list contains some of the most common reasons patients see a physical therapist:

• Back conditions
• Knee problems
• Shoulder/arm conditions
• Neck conditions
• Sprains and muscle strains
• Ankle/foot problems
• Carpal tunnel syndrome, hand/wrist problems
• Hip fracture
• Post-surgical rehabilitation
• Rehabilitation after a serious injury (e.g., broken bones, head injury)
• Stroke rehabilitation
• Problems with balance
• Disabilities in newborns
• Burn rehabilitation
• Pre-/post-natal programs
• Incontinence
• Women’s health
• Licensure & education

All physical therapists must graduate from an accredited bachelor’s or master’s degree program and approximately 45% have advanced degrees. By 2002, all accredited professional education programs will be at the master’s degree level or higher.

What can you do as an insurer to ensure patients get the quality care they need?

Ask yourself the following questions to determine if your benefits packages give policy holders access to appropriate physical therapy services:

1. Do your health insurance plans cover physical therapy without a physician’s referral? In most states patients may see a physical therapist without a doctor’s referral – saving valuable time and money for patient, doctor and insurer.2. Can patients see an “out-of-plan” provider by paying a co-pay or a percentage of the cost instead of a co-pay? Choosing a physical therapist with whom patients feel comfortable is essential to the success of their therapy.

3. Is your physical therapy benefit “bundled” with those of other providers of care? Physical therapy services should be listed separately in the benefit language so that access to necessary services is not compromised.

4. Does the benefit language permit access to physical therapists for each condition during the year? Benefit language should permit treatment of more than one condition in a calendar year (e.g., ankle fracture in January and low back injury in July).

5. Does the benefit language permit access to physical therapists for each episode of care? A person may require more than one episode of care for the same condition. For example, someone with arthritis may receive physical therapy intervention for knee weakness in an attempt to avoid surgery. While this is often successful, some patients may still require surgery for the knee condition (e.g., total knee replacement), which may require post-operative physical therapy treatment. The benefit language should support each “episode of care.”

6. Does the benefit language ensure coverage that facilitates restoration of function? Benefit language that restricts physical therapy care to a 60- or 90-day period imposes an arbitrary limit on recovery. In determining an appropriate physical therapy benefit that will allow an individual to return to his or her previous level of function, benefit language should reflect the normal amount of time that it takes to recover from an injury or from surgery.

7. Does the benefit language ensure coverage that promotes functional independence for those with chronic conditions? Someone who has a chronic condition may need to be seen periodically by a physical therapist. The physical therapist will determine if the individual’s home program, equipment or adaptive devices should be modified. (For instance, children requiring orthotic devices will need modifications to those devices as they grow.) Benefit language should ensure that someone with a chronic condition may receive the kind of care that promotes personal safety and the greatest degree of function possible.

For more information on how physical therapy may better fit into your health care packages, please contact the APTA Department of Reimbursement at www.apta.org or call (800)999-APTA, ext. 8511.