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PT Dilemma: Same Treatment Approach for Different Insurance Types?

September 19, 2010 • Clinical Management • Larry Benz

I have been involved in some interesting PT discussions around the concept of treating patients according to their health insurance. The opinions have been wide and varied.  Interested on feedback from others.  Some of this was addressed in the blog post and subsequent comments on Of Brain or Brawn regarding not seeing patients enough for exercise due to insurance limits.

I promise, the questions are even more straightforward than turning this into a CPT coding and Medicare rules  quiz like we have done before.

3 patients are seen back to back by the same therapist for rotator cuff tendinitis in a private practice.  One patient is 65 years old and has medicare. The second patients is 50 years old and has private insurance which pays roughly $95 per visit for up to 30 visits. The third patient is 45 years old and has a hi deductible insurance and a $35 copay and your company contracts with his insurance company for a max of $50 per visit.  For the sake of discussion, there are no comorbidities or underlying factors-each patient has essentially the same diagnosis and will require identical interventions.


1. If you are the PT, are you concerned at all with their health insurance coverage and benefits?  Would you treat them differently based on those differences with respect to time in clinic, # visits, interventions?

2. Same ques as #1 but you are the owner of the clinic?

3. Would or should a brand new PT treat the patients differently?

4. Does it make a difference if the PT is an orthopedic certified specialist?

5. Does the scenario change if the patient is not at a private practice clinic but a hospital outpatient clinic or center (provider based reimbursement)?

Anybody want to take a stab at this? I am happy to provide my thoughts but thought I would throw this out to our large subscriber base first.

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Larry Benz

Dr. Larry Benz, DPT, OCS, MBA, MAPP, is the President/CEO of Confluent Health. He is nationally recognized for his expertise in private practice physical therapy and occupational medicine. Dr. Benz’s current areas of interest include conducting research and integrating empathy, compassion, and positive psychology interventions within physical therapy. He will be releasing a book in...

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