Leveraging adaptive fitness services to overcome insurance coverage limitations
By: Niki Johnson, MS, ACSM-EP, Senior Exercise Physiologist
As a new year begins, so do new health insurance deductibles and benefits. It’s important to be aware of your healthcare expenses to plan for the year ahead. For those seeking physical rehabilitation services, including physical therapy, it’s important to remember that your health insurance plan may not cover unlimited sessions. Understanding how to make the most of your visits covered by insurance is key to maximizing your benefits. Read on to learn how you can get the most out of your therapy visits while extending the time spent on your recovery to achieve your goals.
Physical therapists provide skilled care to diagnose and treat injuries or physical conditions. However, insurance companies serve many customers and are limited on the number of sessions they approve, which must be deemed “medically necessary.”
The Centers for Medicare & Medicaid Services (CMS) defines medically necessary as, “Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice. These include services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”
If you complete your allotted therapy sessions but have not yet reached your desired level of function, it can feel discouraging. Oftentimes, additional exercise sessions are necessary to help you achieve your goals, but this exercise may not require ongoing oversight from a skilled physical therapist.
To help patients extend their time in therapy and attend a greater volume of guided exercise sessions, Sheltering Arms Institute collaborates with the Sheltering Arms adaptive fitness team in addition to providing skilled therapy services covered by insurance. By incorporating cash-based fitness services into your customized treatment plan, you can continue making progress without quickly depleting your insurance benefits.
For example, if you have a neurological condition and are working to improve your standing endurance, incorporating a NeuroFit exercise session into your schedule every other week between your physical therapy sessions can help you work toward your goal. These sessions guided by an exercise physiologist allow your care team to help you continue your progress while conserving your therapy visits covered by insurance.
Another example: Let’s say your health insurance covers 20 therapy visits per year. You can use 10 sessions for skilled physical therapy, then work with our fitness team to create a maintenance plan until you are ready for the next round of therapy. This strategy can help you maximize your coverage.
We understand that the cost of fitness services may be a concern for some. While Sheltering Arms adaptive fitness programs are cash-based and are not covered by insurance, the cost is often significantly lower than that of skilled therapy and, sometimes, comparable to a co-pay. Additionally, our fitness services can help improve your overall health and well-being, potentially saving you money in the long term by reducing future healthcare needs.
For those who qualify, Sheltering Arms also offers financial assistance to help make these services more accessible.
If you are happy with your progress after completing therapy, we recommend our fitness programs to help you maintain your strength, function, and overall health. Continuing to exercise and make healthy lifestyle choices after therapy is crucial to maintaining your progress. Our licensed exercise physiologists are here to help you get started and provide guidance as you continue your journey.
By combining the expertise of skilled therapists and exercise physiologists, you can extend your time in therapy, stay on track with your physical rehabilitation, and continue making strides toward your functional goals without exceeding your insurance limits.
To schedule an evaluation with a licensed physical therapist or certified exercise physiologist, visit www.shelteringarmsinstitute.com/contact-us or call (804) 764-1000.
