The unfortunate individuals having to deal with adhesive capsulitis (also known as frozen shoulder) many times end up choosing frozen shoulder physical therapy as their treatment choice. If the person has decent insurance this is a wise choice, however since this condition knows no economic boundaries, many times the sufferer has less than adequate insurance and is faced with the possibility that their particular policy will not cover such services.
Traditionally in the past Medicare has always covered physical therapy services provided they are medically necessary. However there has been an ongoing battle in congress on whether to cap physical therapy services after a certain amount has been paid. A cap is very limiting as it usually encompasses other ancillary services. This means that if someone has extensive medical problems they may have very little if any therapy covered by the time they need it. Frozen shoulder physical therapy in particular requires multiple sessions with one-on-one joint mobilization in order to achieve functional range of motion.
Recipients of Blue Cross Blue Shield insurance typically have been covered at the rate of 80/20 – that is 80% insurance responsible and 20% patient responsible. However it is becoming more frequent to see some BCBS policies limiting outpatient therapy to a number of visits per year. Good luck if you have a particularly bad year with more than one injury or surgery requiring PT. Make sure you, as the recipient of health care, do your due diligence towards what your individual policy may cover regarding therapy.
Individuals injuring there shoulder on the job may be covered by Workmans compensation. All employers with greater than 5 employees are required by law to carry Workmans compensation insurance. This does not necessarily mean treatment for your injury is covered. The resulting injury and development of adhesive capsulitis must be documented as work related. Therefore all work related accidents or injuries must be reported to a supervisor who documents the dates and times of the occurrence as the first step. It is also a good idea to keep your own log of dates and times, mileage, etc… if you are injured during the course of performing work duties.
Medicaid recipients will need to check with their provider to see if Medicaid is accepted. If it is, then consult with the therapist directly as to how many units or allowable charges his or her plan of care may require. Medicaid restricts certain charges to a finite number per year.
All-in-all, frozen shoulder physical therapy is covered by most insurance plans in some form or fashion, but each individual will need to due a little investigation to make sure they are covered and do not end up with out-of-pocket expenses.
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