A comprehensive Physical Therapy Evaluation and follow-up treatment program for TMJ/TMD, cervical spine, headaches, and shoulder which includes the entire upper quarter and all related symptoms and dysfunctions requires the appropriate amount of “one-on-one” therapist-to-patient time and attention. Personalized time and attention is required to ensure that all of the appropriate examinations, clinical tests and measurements, manual treatments, therapeutic exercises, home exercises, instruction in ergonomics, and lifestyle management education are provided.
It is our opinion that in our current healthcare system, there has been too much emphasis placed on productivity and profitability by both the payers and the providers. As a result, we have seen longer wait times to see doctors, especially specialists, less direct face time with practitioners in their offices, and often a decrease in attention to detail with minimized follow-up. We have seen an increased focus on specialization with practitioners only willing to provide treatment for their specific area of specialty as a result of potential litigation. We have seen an increase in insurance providers’ attempts to decrease costs by providing the least expensive alternatives for treatment and care, including fewer visits, fewer approvals for diagnostic testing, and restrictions on when and what services may be provided. We have seen insurance companies create and use obstacles to delay or deter quality care, such as pre-authorizations, continued authorizations, renewed authorizations, decreased annual maximums, exclusion of pre-existing conditions, and even post-treatment review determinations to create encumbrances upon patients and practitioners alike. We have seen insurance companies limiting access to care by using only their “preferred” in-network (contracted) providers. We have seen insurance companies increase premiums, increase deductibles, increase patient coinsurances, while concurrently decreasing coverages, decreasing services allowed, and decreasing payments to save costs. We have seen insurance companies use terms such as “medical necessity” to deny services that were previously deemed “medically necessary” by the patient’s own physicians and specialists.
Lou PT believes that our patients deserve all of the attention to detail and the dedication to their “needs and concerns” as required. Regrettably, because of the aforementioned healthcare system issues we are not able to provide the level of personalized care required on an individual basis while participating with insurance company networks. I am sorry to say that we do not participate with any commercial insurance networks.
