Pelvic Floor PT & Insurance
Ronit Sukenick

Ronit Sukenick

Pelvic Floor Physical Therapy & Your Insurance Coverage

Exploring the reasons why Pelvic Floor Physical Therapy & your Insurance Coverage Don't Mix.

You pay a monthly health insurance premium to help cover any illnesses and/or injuries that may arise. This hefty monthly fee is supposed to be your safety net, but what happens when it isn’t? What happens when you need pelvic floor physical therapy? Where is your insurance safety net? Why don’t they cover this? It does. Insurance absolutely allows for physical therapy for pelvic floor-related dysfunction. That isn’t the problem. Finding a pelvic floor specialist, especially a good one, that will accept the pittance of reimbursement that insurance provides is the problem.

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Let’s put this into perspective. Imagine going to physical therapy for an ankle sprain or back pain and being one of 4-6 patients that your physical therapist is treating at the same time. Now picture that after your allotted minutes with your physical therapist placing their hands on you (if you are lucky) that they set you up with some electrical stimulation and a hot pack or hand you off to a PT aide to watch you do your exercises. A bit odd, right? You might think that they’re bad people, lazy, or just don’t like you, but that’s not the case. This speed-date version of physical therapy is a common occurrence because just to put food on their table they need to see 4-6 patients in an hour.

With reimbursement rates being as low as $15/visit in some cases, who could blame them? Seeing 4-6 patients at a time becomes almost a necessity. Now imagine going to physical therapy for your incontinence, painful sex, constipation, or pelvic pain symptoms and being one of the 4 patients being treated at the same time. Imagine being rushed to get to a level of comfort that would allow for your pelvic floor physical therapist to begin your treatment session.

 

If you have ever been to pelvic floor physical therapy you know that it takes a hell of a lot more time than 8 minutes to even get comfortable with some of the treatment techniques needed. So here you are, one of 4 patients, feeling out of your comfort zone and trying not to notice your pelvic floor physical therapist running between 4 different patients in the same 15-minute interval, placing their hands all over, and in you, one at a time! Sounds like an absolute nightmare, am I right? This is why most pelvic floor specialists don’t accept insurance to begin with. Insurance coverage, or lack thereof, isn’t the only obstacle pelvic floor physical therapy is faced with. There are so many barriers to getting help with a pelvic floor diagnosis. For one, we don’t have enough pelvic floor specialists to treat the number of patients that need therapy. There aren’t even enough physicians and other healthcare providers that are knowledgeable about pelvic floor dysfunction to diagnose it correctly and refer it appropriately.

 

Hell, there aren’t even enough healthcare providers that will listen and believe their patients’ symptoms  ⸺ which is another issue altogether. When there aren’t enough providers that even know that pelvic floor physical therapy exists as a treatment option and patients that don’t feel comfortable discussing their potentially embarrassing symptoms, the path to pelvic floor rehabilitation becomes muddled. Suddenly it becomes a broken record and those patients that need pelvic floor physical therapy the most are left oblivious to the fact that although their symptoms may be common, they are not normal, and can be treated.

To add insult to injury, insurance companies also love to tell patients how many visits it should take them to get better. Sure your plan may tell you that you have 60 visits per year of physical therapy available, but you aren’t always granted those visits. Insurance companies will still require you to ask permission to use those visits. The number of visits isn’t dependent on how long it might take your body to heal nor is it up to the suggested rehabilitation plan from your physical therapist.

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After your evaluation, your physical therapist has to plead your case to the insurance company, using their medical notes to ask for visits to treat your condition, then someone in the insurance company’s back office gets to make that decision for you. Let’s just hope they are having a good day and have some idea of where a pelvis is. If not, you could be left with 4-6 visits to heal from a 9-month pregnancy and vaginal or C-section birth within a 4-week timeframe. Want to try and appeal that decision? Good luck. You may squeeze out an additional visit here or there, but most of the time they give you dribs and drabs of visits then deny you the rest. Your insurance company doesn’t care that your doctor says you need physical therapy 2-3x per week for 12 weeks. They get to dictate the plan because they foot the bill. Still doesn’t make any sense, does it?

 

Why does your insurance, knowing nothing about pelvic floor rehabilitation first-hand, get to decide your treatment plan? That’s the golden question, so before we start screaming about getting physical therapy for everybody with a pelvic floor diagnosis, let’s make sure we are asking for the right thing. We aren’t looking for insurance to cover physical therapy for a pelvic floor diagnosis, they already do. What we need is for insurance companies to increase their reimbursement rate to match the time and post-graduate education required to treat patients with pelvic floor dysfunction. Physical therapy, in general, should be reimbursed at a higher rate, but that would require a major shift in the priorities of our healthcare system so we’ll save that debate for another day.

 

What we need now is to guarantee quality care from qualified pelvic floor specialists with higher reimbursements to account for the level of treatment given. With there being very little difference between poor access to physical therapy and access to poor physical therapy, we need to start somewhere. What better place to start than addressing one of the many issues pelvic floor physical therapists, and their patients, face day in and day out.