does insurance cover PT/pounding ?

S

southbound

New member
hi folks,
i'm at a point in my life where i need to seriously consider a form of pulmonary therapy.. right now, pounding seems to be the only thing i can do.. no vest, no flutter, no accapella..

i have a few questions and i dont know where else to look..

1) is this something that can be covered by insurance? like, does it fall into the physical therapy catagory or something..

2) who on earth do you go to for something like this? are there trained pounders?

i have no one else who is willing to do it, so i need to reach out..

thanks
 
S

southbound

New member
hi folks,
i'm at a point in my life where i need to seriously consider a form of pulmonary therapy.. right now, pounding seems to be the only thing i can do.. no vest, no flutter, no accapella..

i have a few questions and i dont know where else to look..

1) is this something that can be covered by insurance? like, does it fall into the physical therapy catagory or something..

2) who on earth do you go to for something like this? are there trained pounders?

i have no one else who is willing to do it, so i need to reach out..

thanks
 
S

southbound

New member
hi folks,
i'm at a point in my life where i need to seriously consider a form of pulmonary therapy.. right now, pounding seems to be the only thing i can do.. no vest, no flutter, no accapella..

i have a few questions and i dont know where else to look..

1) is this something that can be covered by insurance? like, does it fall into the physical therapy catagory or something..

2) who on earth do you go to for something like this? are there trained pounders?

i have no one else who is willing to do it, so i need to reach out..

thanks
 
M

MCGrad2006

Guest
There is a company in the Boston area that does specifically Chest PT. They come to your house and do it for you. If you want that info, PM and I will get it to you. I dont know about other parts of the country tho. Insurance should cover this stuff, Chest PT and the vest.
 
M

MCGrad2006

Guest
There is a company in the Boston area that does specifically Chest PT. They come to your house and do it for you. If you want that info, PM and I will get it to you. I dont know about other parts of the country tho. Insurance should cover this stuff, Chest PT and the vest.
 
M

MCGrad2006

Guest
There is a company in the Boston area that does specifically Chest PT. They come to your house and do it for you. If you want that info, PM and I will get it to you. I dont know about other parts of the country tho. Insurance should cover this stuff, Chest PT and the vest.
 
J

JazzysMom

New member
If you dont have any home health agencies near you that can offer CPT then try your local hospital and ask their respiratory department for guidance. Between manual CPT, the percusser, the vest, flutter and acapella there should be something the insurance covers. Inquire at your CF clinic....they should be able to guide you!
 
J

JazzysMom

New member
If you dont have any home health agencies near you that can offer CPT then try your local hospital and ask their respiratory department for guidance. Between manual CPT, the percusser, the vest, flutter and acapella there should be something the insurance covers. Inquire at your CF clinic....they should be able to guide you!
 
J

JazzysMom

New member
If you dont have any home health agencies near you that can offer CPT then try your local hospital and ask their respiratory department for guidance. Between manual CPT, the percusser, the vest, flutter and acapella there should be something the insurance covers. Inquire at your CF clinic....they should be able to guide you!
 
B

blindhearted

New member
You will need to talk to your Insurance Company to see if they cover it. If so for how long. And I'm sure the doctors will have to prove that the Vest and other ways of Chest Therapy doesnt work for you. I had Nurses and / or Respiratory Therapist doing Manual CPT on me until 19. Nurses from 3 to 15, RRTs from 15 to 19. There were times the insurance company gave us heck because paying someone to do it wasnt as "cost efficient" as purchasing a Vest. They finally forced me to get the Vest. I think manual CPT is the best for me. That is why my husband beats on me at night for me. If you do get approved, they should come out to your house, ususally 2-3 times a day. Ususally by their schedule, you work around them, which can be very annoying. And if someone is sick, and no one can cover them, you will get no treatments that day. And also understand that after a certain hour...like 6pm or so, they are off for the day so you are on your own for night time treatments. My mom had to do one for me until my husband came along.
 
B

blindhearted

New member
You will need to talk to your Insurance Company to see if they cover it. If so for how long. And I'm sure the doctors will have to prove that the Vest and other ways of Chest Therapy doesnt work for you. I had Nurses and / or Respiratory Therapist doing Manual CPT on me until 19. Nurses from 3 to 15, RRTs from 15 to 19. There were times the insurance company gave us heck because paying someone to do it wasnt as "cost efficient" as purchasing a Vest. They finally forced me to get the Vest. I think manual CPT is the best for me. That is why my husband beats on me at night for me. If you do get approved, they should come out to your house, ususally 2-3 times a day. Ususally by their schedule, you work around them, which can be very annoying. And if someone is sick, and no one can cover them, you will get no treatments that day. And also understand that after a certain hour...like 6pm or so, they are off for the day so you are on your own for night time treatments. My mom had to do one for me until my husband came along.
 
B

blindhearted

New member
You will need to talk to your Insurance Company to see if they cover it. If so for how long. And I'm sure the doctors will have to prove that the Vest and other ways of Chest Therapy doesnt work for you. I had Nurses and / or Respiratory Therapist doing Manual CPT on me until 19. Nurses from 3 to 15, RRTs from 15 to 19. There were times the insurance company gave us heck because paying someone to do it wasnt as "cost efficient" as purchasing a Vest. They finally forced me to get the Vest. I think manual CPT is the best for me. That is why my husband beats on me at night for me. If you do get approved, they should come out to your house, ususally 2-3 times a day. Ususally by their schedule, you work around them, which can be very annoying. And if someone is sick, and no one can cover them, you will get no treatments that day. And also understand that after a certain hour...like 6pm or so, they are off for the day so you are on your own for night time treatments. My mom had to do one for me until my husband came along.
 
C

cdale613

New member
Some insurers definitely cover chest PT. They may not want to, but if you and your docs put up a big enough fight, it is possible to get them to cover you.

Ways to make it easier:

Call your insurer and ask to have a case manager assigned to you. Otherwise, every time you call your insurance company its like starting from scratch.

Insurers HATE to cover ongoing home-based care, and will look for any reason not to do so. The favorite excuse they will try to use is that "since you're not home-bound, we don't cover it" don't let them use this. Have your doc write them a letter of necessity explaining the importance of Chest PT, and fight the suggestion of going to an outpatient setting by 1) the increased risks of infection by being around other patients who may have CF 2) The inability to do your nebs right after your session because you have to drive back to your house. Again, having a case manager who you have explained CF to, and your daily regiment to will help this.

I was also forced to get a vest first, but was able to successfully argue that it was ineffective and not cost efficient for the insurance company after needing a cleanout 3 months after a previous cleanout, using the vest in between. I was able to convince them to let me try CPT for 3 months and see if I did better, and I haven't had a cleanout since. (1 Year ago). They don't bug me anymore about paying for CPT.

Here are some reasons you can give them about why you need CPT instead of the vest:

1) The positions of CPT point my bronchial tubes toward the ground, using gravity to help clear my lungs while being pounded on - the vest doesn't

2) Stopping to rotate positions makes me stop and cough - the vest doesn't do that

3) If you find you have had compliance issues in the past, nothing makes you more compliant than having a scheduled time when your therapist knocks on the door. Tell the insurance company that with CPT they know you're using the treatment - with the vest, they pay for it whether you use it or not.


Don't be suprised if they resist paying for daily CTP, but fight with them and try to get at least 3 days a week. My current situation is 3 days a week, but daily if I am doing a home cleanout.


Good luck!

Chris

26 w/CF
 
C

cdale613

New member
Some insurers definitely cover chest PT. They may not want to, but if you and your docs put up a big enough fight, it is possible to get them to cover you.

Ways to make it easier:

Call your insurer and ask to have a case manager assigned to you. Otherwise, every time you call your insurance company its like starting from scratch.

Insurers HATE to cover ongoing home-based care, and will look for any reason not to do so. The favorite excuse they will try to use is that "since you're not home-bound, we don't cover it" don't let them use this. Have your doc write them a letter of necessity explaining the importance of Chest PT, and fight the suggestion of going to an outpatient setting by 1) the increased risks of infection by being around other patients who may have CF 2) The inability to do your nebs right after your session because you have to drive back to your house. Again, having a case manager who you have explained CF to, and your daily regiment to will help this.

I was also forced to get a vest first, but was able to successfully argue that it was ineffective and not cost efficient for the insurance company after needing a cleanout 3 months after a previous cleanout, using the vest in between. I was able to convince them to let me try CPT for 3 months and see if I did better, and I haven't had a cleanout since. (1 Year ago). They don't bug me anymore about paying for CPT.

Here are some reasons you can give them about why you need CPT instead of the vest:

1) The positions of CPT point my bronchial tubes toward the ground, using gravity to help clear my lungs while being pounded on - the vest doesn't

2) Stopping to rotate positions makes me stop and cough - the vest doesn't do that

3) If you find you have had compliance issues in the past, nothing makes you more compliant than having a scheduled time when your therapist knocks on the door. Tell the insurance company that with CPT they know you're using the treatment - with the vest, they pay for it whether you use it or not.


Don't be suprised if they resist paying for daily CTP, but fight with them and try to get at least 3 days a week. My current situation is 3 days a week, but daily if I am doing a home cleanout.


Good luck!

Chris

26 w/CF
 
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