I had my last approved physical therapy visit today; TriCare has disapproved any continued treatment because "the beneficiary has been in physical therapy for the past 2 [sic] years", "the beneficiary is able to exercise per her own program" and as there is "no new functional loss for which a rehabilitation goal has been established, maintenance therapy and exercises for strength and endurance is excluded from coverage, and the beneficiary has had ample time to learn strengthening exercises, conditions for coverage are not met and the request is denied."
|Working on releasing scar adhesions with pressure point therapy;|
the ultrasound is not G-rated, so no photos of that!
I think I speak for everyone who has on-going rehab/therapy - if I didn't need to go, I most certainly would prefer not to.....I am now going through appeals process to try and get the visits covered; if not, I will be paying out of pocket. That's just how it is; I have gone several times without treatment for several weeks and the end result is significant pain in both my abdomen and back, misalignment and more adhesions.
As I finish this, I have just gotten off the phone with the TriCare call center. So, in addition to submitting an appeal, my PCM also needs to resubmit to try and get approval for treatment using a different diagnosis code. The best line "well, do you know if it's a 625.9 diagnosis code or a 789.00 diagnosis code?" Ummm...no, I don't really, 'cause that's a clinical/medical thing and I didn't make that analysis. Sigh....
Oh, well. These are just the little thorns on the roses of my life. Nonetheless, grateful they bloom in the sun and smell sweetly in the summer air, just have to figure out how not to get stuck, right?