Doctor Versus Physical Therapist

When my knee MRI back in May showed bursitis and patellafemoral pain syndrome (PFPS), my doctor sent me off to physical therapy. The physical therapist was thorough and wonderful, as she assessed my condition and the contributing factors. She was able to fully understand why my knee hurts — all the components that worked together to cause my injury; my pelvis, my feet, my butt, my leg strength, the way I sit, etc. Based on what she learned, she took me through a series of exercises twice a week to get myself better and pain free.

She had me try out spin; she had me try out running. Then it was time for my follow up visit with my doctor.

Last week, I went to the doctor and he examined my knee. He said he still felt the bursitis and the PFPS and recommended continuing physical therapy. He also recommended that I see a podiatrist and get fitted for an orthotic insert for my shoes. He said this will help with my alignment problems, as my alignment is a major contributor to my knee pain.

I was very worried. Orthotics cost hundreds of dollars! Hundreds of dollars that I don’t have, given the amount of doctor visits, tests, prescriptions, other treatments that I am partially responsible for. And in addition to the $500 a month that I pay to even HAVE medical insurance.

I went to my PT that evening and told her about the conversation with my doctor. As soon as I said the word “orthotic” she immediately began shaking her head.“Bad idea?” I asked. The PT explained that I don’t NEED it. I would if my alignment problems were coming from my feet — but in my case, my alignment is off because of my pelvis. It was clear to her during every assessment and exercise she had me to. She had absolutely no doubt that foot orthotics would not help at all, would be an extreme waste of money, and would likely make my knee problems WORSE. And you remember the letter my PT wrote to my doctor — she obviously understands my condition.

Of course, I was happy. That is what I wanted to hear! But then I started getting annoyed… and then angry at my doctor. Why would he send me off — without checking to see if I NEEDED it — to another doctor for something I don’t need that costs a few hundred dollars!? (I need an interrobang symbol in here) Why not first find out if it would be worth it? It has been suggested to me that since I am not a surgical candidate, I am now a waste of his time and he doesn’t want to be bothered with me, so he was sending me off to someone else. But I think it is less cut and dry than that. I think he was doing what he thought was the next step according to his script. I don’t think he took the time to ask or wonder about the cause of my alignment issues. Not his problem. Furthermore, I went there complaining of shoulder pain much worse than my knee, and he didn’t even examine my shoulder — just wrote another prescription for more physical therapy. I am sure PT will have a much clearer understanding of my shoulder problem, regardless of the MRI, based on her actually… um… examining it.

Uhhhh.

Round 1: Doctor Versus Physical Therapist
Winner – Physical Therapist

Have I mentioned how frustrated I am that doctor’s don’t CARE?

I am getting an MRI for my shoulder tomorrow and should have answers later this week. I was trying to find out how many PT visits I have left for 2009 and came across some roadblocks (ie, stupid insurance company):

1. Depending on how many visits I have left for 2009, I was not sure if I should go for knee, shoulder or both
2. I couldn’t get a clear answer on how many I have left

I was extremely frustrated by the fact that I didn’t know how many sessions I have left. I have called my insurance numerous times. My PT place has called my insurance numerous times. We were both given completely different answers.

Here is the story. I get 20 physical therapy visits a year with my insurance. I went to PT at the beginning of the year for my shoulder, 6 times. I went to PT for my knee 12 times. That would leave me with 2 visits left — not enough to do shoulder again, just enough to wrap up knee. Sounds simple, right?

When I called my insurance to confirm, they told me that a bunch of my PT visits were charged as Occupational Therapy (OT). I get a separate 20 OT visits in addition to my 20 PT visits. Because of that, I have more PT visits left than I realized.

I called my PT place to tell them this. They called my insurance. Three times — and were told that it is all combined, I definitely only have 20 visits total a year. I called my insurance three times as well. The first two times I was given incorrect and OT-ridden information. The final time I finally got my answers.

Whoever pulled that OT information was wrong. Each PT is billed by name. Their name is associated with what they do. The charges can’t be split between two services if the therapist is certified to do only one of those services. I called the billing department of both PT offices and was told an OT bill was impossible.

After extensively going over every single date with a very nice woman on the phone on my third phone call, I  finally received my answer — I have 2 visits left. I had asked her to go over every PT visit I had this year. She did so and never once mentioned anything about OT. I trust her. Why everyone that works at the insurance company has different answers to the same questions is beyond me. I don’t understand anything about health care in this country; every time I think something can’t confound me more, it does. Like the time I had to pay $320 for a prescription. When I already pay $500/mo for health insurance. Anyway…

As we went through each date, it was finally clear that I went to PT 18 times this year (although we hung up thinking 17 — when I go through my notes it seems to be 18. I will stick with that). Therefore, I have two visits left. My plan for the next two visits (not yet discussed with my PT) is as follows:

This week – No visit (wait until shoulder MRI  results arrive)
Next week – Contingent upon shoulder MRI results, either — one hour evaluation of shoulder or regular knee PT
Following week – Contingent upon shoulder MRI results, either shoulder PT session to learn exercises for home or regular knee PT

I think that is a good plan! Let’s all hope I don’t get into some kind of accident and need serious PT this year because, well, I’m out of visits! And the year is not even halfway over.

As for my doctor? I haven’t told him I barely have any visits left. I’m not sure what he will advise going forward to get better, but I will be going there in a couple weeks and I will take it from there. Hopefully he won’t send me off to another expensive service that I don’t need. At least this time, I have a great PT I can ask — one who knows what she is doing and cares about my health. Which is more than I can say for my doctor.