Our Healthcare System Has Failed Us
I think we can all agree that the navigating the healthcare world is a headache. Trying to figure out co-pays, deductibles, covered vs non-covered services, in-network vs out of network providers… it’s just never ending cycle. Most major insurance companies will cover medically necessary services- which sounds great- but their definition of medically necessary leaves much to be desired. From a physical therapy standpoint, this means that services are covered when they are restorative in nature- related to pain, an injury, decline, or other adverse event. And even then insurance often has the final word, capping the number of visits or determining which providers you can see under your benefits. There is also a lot of false information out there- especially surrounding Medicare. If you are a Medicare beneficiary, there is no maximum number of visits or dollar amount each year, although services still have to be deemed medically necessary. So what happens after you’ve finished therapy and are looking for more of a maintenance program? Well those programs- despite the known benefits of preventative care- are out of pocket costs. It doesn’t matter what your insurance is, or how good you think your coverage is- wellness or maintenance programs are not covered. The problem is for so many Americans- especially our older adults and those with chronic or progressive conditions- regular physical activity is a necessary part of maintaining health. Traditional physical therapy helps people get better but then the wellness or ‘staying better’ part of the picture remains a challenge.
So if you fall into one of those categories that I just mentioned, here are a few things to consider.
Preventative care, including wellness and fitness services, can reduce future healthcare costs. If you are unable to stay active or generally inactive, your independence, health and well-being could decline. If this happens, there are extra costs to consider- caregiving support, home set up (can you still stay in your home?)- these are out of pocket costs. If you just wait until the next time you are eligible for therapy services, you are essentially waiting for a change to happen, and it often isn’t a good one. It just perpetuates this ‘sick patient’ model where we wait for something to occur in a reactionary manner instead of trying to be proactive and taking control of our health. Older adults and those with conditions like Parkinson’s or MS (amongst others) may need therapy services repeatedly as time goes on- and those times should be utilized to maximize health and well-being as much as possible. Incorporating more proactive wellness services can help fill in the gap to maintain health and lessen any potential changes or declines that occur.
Our healthcare system has failed us
We are conditioned to only utilize insurance covered services and if they are not covered, then we are often not interested. But it’s time that we start investing in our health because insurance companies surely don’t, They conveniently step in after the fact to help rebuild but don’t take part in laying a solid foundation. For now, medically necessary leaves out preventative care but hopefully with continued advocacy demonstrating the importance at a human level, that will change. Think of investing in wellness services as an investment in your health- helping to keep you active today so you don’t have to worry about the repercussions, financial costs, or other burdens at a later date.
How Let’s Get Moving can help
Each program is individualized and the duration depends on your need. The overall goal is to promote health through movement and empower people to be as active as possible, inclusive of all ages and diagnoses. There are various in-person and virtual support programs available to design a program that meets your needs and helps you reach your wellness goals. Learn more here.
