Why pay cash or out of pocket from insurance for Physical Therapy? Every year more and more of our patients are paying cash out of their own pockets for our physical therapy services. Like most health care providers, we bill insurance companies as a service of convenience for our patients. In recent years, deductibles have climbed to $5000 or more, copays have become higher, and scrutiny by insurance companies over what is covered has increased. We are now at a point where many of our patients/clients have lower out-of-pocket expenses if they simply pay for our services without going through their insurance carrier.
Government regulators allow us to provide discounts if sessions are paid for by the patient on the day of service, with further discounts if they pay for multiple sessions. We can afford to offer these discounts because we significantly reduce our administrative expense if we are not billing your insurance company and then waiting for 30-90 days or more to get paid (unfortunately that is not unusual). As the patient you have less cost, however your payment to us does not apply to your deductible. If you have a flex spending account or health savings account, your payments to us may be reimbursed.
Often spending two to three sessions focusing on your issue is very productive and can actually save you time and money in the long run. This is especially true if you have a high deductible plan.
Some physical therapy practitioners and clinics will accept a “fee for service” reimbursement or “capitation”. In the last few years insurance companies have cut back on physical therapy insurance reimbursement 30-50%. Physical Therapy clinics that accept a capitated rate may have to reduce time spent directly with a Physical Therapist. Often a co-pay of $30.00-$40.00 is required for a 30 minute treatment. That combined with meeting your deductible, and now you are paying more for PT, than if you paid cash.
If you have a high deductible plan, $2000.00 or greater, you are essentially paying out of pocket. Why not make the choice where you want to go? NOT where your insurance or your health network dictates?
With overuse of opioids for the treatment of chronic pain becoming a national public health epidemic, the Centers for Disease Control and Prevention (CDC) released guidelines that recommend nondrug approaches such as physical therapy over long-term or high-dosage use of addictive prescription painkillers.
"Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain," the guidelines state ("CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016" - March 15, 2016). "Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate."
While there are certain conditions - including cancer treatment, palliative care, and end-of-life care - where opioid prescription for chronic pain may be appropriate, the CDC cited numerous cases where opioid use could be significantly reduced or avoided altogether.
"The contextual evidence review found that many nonpharmacologic therapies, including physical therapy, weight loss for knee osteoarthritis, psychological therapies such as CBT (cognitive behavioral therapy), and certain interventional procedures can ameliorate chronic pain," the guidelines state. "There is high-quality evidence that exercise therapy (a prominent modality in physical therapy) for hip or knee osteoarthritis reduces pain and improves function immediately after treatment and that the improvements are sustained for at least 2-6 months. Previous guidelines have strongly recommended aerobic, aquatic, and/or resistance exercises for patients with osteoarthritis of the knee or hip. Exercise therapy also can help reduce pain and improve function in low back pain and can improve global well-being and physical function in fibromyalgia."
Physical therapists partner with patients, their families, and other health care professionals to manage pain, often reducing or eliminating the need for opioids. Research has shown that a simple education session with a physical therapist can lead to improved function, range of motion, and decreased pain.
Before you agree to a prescription for opioids, ask if physical therapy might be right for you.
Working With Combat AthletesSports that involve fighting are among the most challenging and stressful—not to mention dangerous—competitions.Combat athletes compete in many different sports. While some—such as wrestling, boxing, and karate—have been practiced for hundreds or even thousands of years, others, such as mixed martial arts (MMA) and Brazilian jiu jitsu (BJJ), are new to the scene. (The term "combat sports" describes a competition whose essence consists of direct combat between 2 competing athletes.
Similar to athletes in other pro sports—as well as to tactical athletes, including military personnel, police, and firefighters—combat sports athletes' continued employment relies on their physical performance and, ideally, avoiding injury. However, the physical demands of combat sports mean that injuries occur more frequently than in other sports. In MMA, for example, a number of studies have found an injury rate of 24-29 per 100 fight participations.
Both women and men compete in combat athletics. Women compete in judo in the Olympics as well as at other levels; MMA fighter Ronda Rousey was an Olympic judo bronze medalist before transitioning to MMA, where she won the UFC (Ultimate Fighting Championship) women's bantamweight championship. Holly Holm was a professional boxer and kickboxer before defeating Rousey to win the UFC bantamweight championship. Amanda Nunes, the current MMA bantamweight champion, started training in karate at age 7 and pursued training in boxing at the age of 16. She holds a black belt in BJJ and a brown belt in judo. In fact, many women combat athletes have practiced multiple martial arts.
Physical therapists work with these athletes focus on minimizing injuries, addressing those that do occur, and extending the careers of the athletes.
We analyze technique and identify the sources of the movement problem from the individual, then complete manual therapy, stretches, strengthening, and neuromuscular reeducation, and build back up into reintegrating appropriate movement into the specific problem area to maximize performance.
While conditions and injuries for combat sports athletes can vary, the most common injuries are rib injuries, thoracic restrictions, lower back pain, knee pain (frequently meniscal or at the iliotibial band or medial region), hip impingement and pain, ankle sprains, elbow hyperextension (often among "newbies" to their sport, she says), postconcussion headaches, and chronic whiplash.
We can also see a lot of shoulder impingement syndrome (SIS), which frequently occurs because the athletes have been taught to protect their chin while throwing jabs by "putting on a hoodie"—bringing their shoulders up and forward, as if shrugging into a jacket.
Many of these patients stay in 'fight stance,' continuing to cover their chin as they go to their [daytime or salaried] jobs, and the anterior tipping of the scapula will frequently, over time, cause partial supraspinatus tears if not addressed, For these patients, my first goal is to fully normalize thoracic mobility, costal mobility, and cervical mobility through manual interventions. Ribs 1-4 are very frequently restricted in these patients. Soft tissue work and stretching instruction usually is needed."
It's also important to assess lumbar and hip mobility and lumbopelvic stability, as many of these patients are using their upper body to power their punches instead of rotating through their hips and pelvic girdle, and incorporating their whole body in delivering the strike.
Regarding chronic injuries, Lou sees a lot of low back and shoulder pain. Each fighter is different, but a large contributing factor I've seen is from the fighter's posture—rounded shoulders, pitched forward—compounded by the dominant patterns in specific types of combat sports such as wrestling, judo, and jiu jitsu.
In the realm of MMA, the most common injury location is the head and face—predominately the nose, eyes, and jaw regions. This is followed by the lower extremities and then upper extremities.
The upper and lower extremities tend to follow distal to proximal locations with regard to higher injury rate,The hand typically suffers a higher injury rate, followed by the elbow and then the shoulder. The lower extremity follows the same pattern, with the toes having the highest injury rate, followed by the ankle and then the knee. The research shows this across multiple studies.
Combat Sports & Terminology in BriefHere are brief summaries of some of the sports and terms mentioned in this blog .
Boxing, both amateur and professional, involves attack and defense with the fists. Boxers wear padded gloves and generally observe the code set forth in the Marquess of Queensberry rules. Matched in weight and ability, boxing contestants try to land blows while attempting to avoid the blows of the opponent. A boxer wins a match either by outscoring the opponent—points can be tallied in several ways—or by rendering the opponent incapable of continuing the match. Bouts range from 3 to 12 rounds, with each round normally lasting 3 minutes.1
Brazilian Jiu-Jitsu (BJJ) is a martial art and combat sport that teaches a smaller person how to defend himself or herself against a larger adversary by using leverage and proper technique. The Gracie family, founders of BJJ, modified judo and traditional Japanese jujutsu to create the art. It contains stand-up maneuvers but is most known for its ground-fighting techniques. Gaining superior positioning—so one can apply the style's numerous chokes, holds, locks, and joint manipulations to an opponent—is the key in BJJ.2 Fights may be won by submission or by points awarded by the referee.
Chokes are submission moves that apply pressure to the neck, cutting off blood to the brain. A player who does not "tap," or submit, will lose consciousness.3
Joint Locks are moves that apply pressure to a joint and push it in an "unnatural" direction (ie, locking an arm and forcing an elbow backward). This restricts an opponent's movement and/or causes him or her to submit due to pain and/or potential for a hyperextension injury or broken bone.
Jujutsu is a Japanese martial art and method of close combat for defeating an armed and armored opponent while using no weapon or only a short weapon. Because striking an armored opponent proved ineffective, practitioners learned that the most efficient methods for neutralizing an enemy took the forms of pins, joint locks, and throws. These techniques were developed around the principle of using an attacker's energy against him or her, rather than directly opposing it.4
Karate developed out of martial arts forms practiced on Okinawa, an island now part of Japan. The word karate is Japanese for "open hand" (kara means open and te means hand). Te signifies that the main weapon is the body. Instead of an arsenal of swords or guns, the "karateka" cultivates a personal arsenal of punches, kicks, and deflection techniques. Kara relates to the psychology of karate. Karatekas are open to the world around them, making them better equipped to handle any attack.5 Historically, and in some modern styles, grappling, throws, joint locks, restraints, and vital-point strikes also are taught.
Krav Maga is a tactical mixed-martial art/combative and self-defense system that combines boxing, judo, jujitsu, and aikido. It was developed for the Israel Defense Forces and Israeli security forces. The primary goal, to neutralize a threat as quickly as possible, governs all the other principles of Krav Maga. It consists of strikes, holds, and blocks. The fighter looks to combine an offensive movement with every defensive movement.6
MMA (Mixed Martial Arts) is a full-contact sport that allows a variety of fighting styles to be used (including martial and non-martial arts techniques). Striking and grappling techniques, either standing or on the ground, are permitted. The early years of the sport saw a wide variety of traditional styles, but it is now common for fighters to train in multiple styles, creating a more balanced skill set.7 A competitor may win by submitting his or her opponent (forcing the opponent to concede the match), knocking out the opponent, prompting a referee stoppage (technical knockout), accumulating the most points from the judges, or causing an injury that results in a doctor's stoppage.
Muay Thai or Thai boxing is the Thai national sport. In Muay Thai, competitors fight standing as in Western boxing, but elbows, knees, and kicks strikes are allowed, with the only protection being the gloves. An important part of this fighting style is the clinch (standing wrestle).
Seniors wrestle with a variety of medical issues that can make it more difficult to stay steady on their feet. Each year, more than one-third of people age 65 or older fall. Of those who fall, up to 30 percent suffer moderate to severe injuries, such as hip fractures, and increase their risk of early death, according to the CDC. Falls and related injuries can seriously impact a senior’s life, limiting certain activities or even making it impossible to live independently.
Balance exercises are crucial to help prevent falls by improving a person’s ability to control their body. Frequently doing a few simple, at-home exercises will help seniors enhance their coordination and decrease the risk of falling.
One great thing about exercises to improve balance is that they can be done as often as you wish, anytime, anywhere. Before you begin, make sure you have a sturdy chair, person, railing or countertop nearby to hold on to if you feel unsteady. It’s also a good idea to talk to your doctor about any exercise-related concerns. Don’t engage in anything that feels overly uncomfortable.
Here are four balance exercises for older adults:
1. Stand on one foot. We’ll start off simple. Find a sturdy chair to stand behind and hold on to for balance. Lift one foot up and hold it for 10 seconds. Repeat this 10 to 15 times, then switch and do the same thing with the other leg. It may be easier to stand on one leg than the other – this is totally normal. Once you perfect this move, try reaching your raised foot as far as you can out to the front.
2. Walk heel to toe. Start by putting one heel in front of the toes of your other foot. You want your feet to touch. If they can’t touch, get them as close as you comfortably can. Choose a spot in front of you to focus on. Start walking, putting one heel in front of the toes on your other foot. Walk 20 steps like this, staring at your spot for balance.
3. Rock from side to side. For this exercise, begin by placing your feet hip width apart, pressing into the ground with the same force in each foot. Slowly transfer your weight to one side, lifting the opposite foot. Hold it up for for 20-30 seconds. Transfer the weight back into both feet and repeat on the other side. Repeat this process five times on both legs.
4. Balance walk. Pretend you’re a tightrope walker in the circus. Raise your arms out to your sides, parallel to the floor. Choose a spot ahead to focus on and walk towards. Start walking in a straight line. As you walk, lift your back leg up and hold it for a few seconds. Repeat this while alternating legs, walking 20 steps.
As your balance gets better, you can modify these exercises to make them more difficult. To challenge yourself, try holding onto the chair with only one hand. With time, try holding on with only one finger and, finally, with no hands. Once you’re steady on your feet, try doing the exercise with your eyes closed.
As you age, it’s important that you are able to balance well. Steady balance is essential to avoiding dangerous falls. Start small, doing a few repetitions of these exercises every couple days, gradually allowing your coordination to get better. Staying active will help keep you or your senior loved one’s body and mind healthy and happy.
Start using these balance exercises for fall prevention today.
Questions? Feel free to call us at 858-792-1124 or email us at email@example.com today
Kenneth Mauck, MPT, MS , Manual Therapy Expert