Here at PHRC we are not Medicare providers, for good reasons; you may remember that PHRC published a blog post about them. Still, we receive calls almost daily from Medicare patients enquiring about treatment from us, and unfortunately we have to turn them down: the law says, oddly, that we cannot provide treatment to Medicare patients even if they are willing and able to pay for it. This can be very frustrating, and can even feel discriminatory. Jarod Carter, PT, DPT has written many blogs on Medicare laws with regards to physical therapy. If you are a Medicare patient and would like to know more about the laws and your rights, please check out Jarod’s blog. Recently I wrote a letter to my Senator about the unfairness of these laws: you can read it below. If, after reading it, you feel inspired to take action as well, you can sign the American Physical Therapy Association’s advocacy letter here.
The Honorable Dianne Feinstein Date: July 18th, 2016
United States Senate
331 Hart Senate Office Building
Washington, D.C. 20510
Dear Senator Feinstein,
Allow me to introduce myself. My name is Malinda Wright and I am a physical therapist in Los Gatos, CA. I am writing to ask you to please support the Medicare Patient Empowerment Act (H.R.1650/S. 1849), which will allow physical therapists to opt out of Medicare. According to the Medicare Benefit Policy Manual, and also outlined in the Balanced Budget Act of 1997 and Medicare Prescription Drug Improvement and Modernization Act of 2003, physical therapists are not allowed to opt out of Medicare. Other healthcare professionals, such as physicians, nurses, midwives, psychologists, clinical social workers, dietitians, and nutritionists are designated as “providers” and are allowed to opt out.1 Physical therapy is considered a “service,” a distinction that does not sit well with me. We see patients all the time for whom physical therapy is in fact the appropriate course of treatment. They come to us for healthcare provision, not to take advantage of a service. Because of the distinction the current law makes, however, we are not allowed to treat Medicare patients no matter how much they need it.
The non-Medicare practice that I work for specializes in pelvic floor disorders. We treat men and women who have musculoskeletal impairments causing urinary, sexual, and bowel dysfunction, including pudendal neuralgia. It is common for our patients to have seen multiple medical providers (sometimes more than ten) before coming in to see us. Many medical providers are unaware of their conditions and/or do not know how to treat them. This can leave the patients feeling hopeless and abandoned. Many patients turn to the internet for guidance, and find us through our website. Unfortunately, due to Medicare laws, I am unable to treat those patients who have Medicare. It is heartbreaking to have to tell Medicare patients who cannot sit, drive, or work because of their pain that I cannot treat them because the law forbids me to.
We recently had a pair of cases that prompted me to write this letter to you. A woman called our office and reported that she has Medicare insurance. As we often have to do, we politely explained to her that we are not Medicare providers, and referred her to a Medicare provider in her area. A few months later, the same woman called again, and this time she reported she did not have Medicare and wished to schedule an appointment with us. Our receptionist recognized her from the previous phone call, and again went over the rules and regulations surrounding Medicare. She was very angry: she could not understand why we were not allowed to treat her, and said that she felt discriminated against because of her age. Later that same day, I evaluated a 72 year old man from India, and was able to treat him for his tailbone pain at his own expense: as an international visitor, the Medicare laws did not apply to him.
You see the problem: I am permitted to treat a senior patient visiting from India, but legally I am not allowed to treat a senior US citizen of equal means who has the same medical condition. Because Medicare does not allow physical therapists to opt out of the system, I cannot provide treatment to the men and women in my community who are 65 years old or older. I have to say I agree with the woman who called us: this seems like age discrimination.
As well as being saddened that I could not treat her, it bothered me that our caller had felt the need to resort to lying about her insurance in order to qualify for treatment. If the Medicare laws are encouraging patients to lie like this, something is not right and we need to fix it.
Please support the Medicare Patient Empowerment Act (H.R.1650/S. 1849) and allow Medicare patients the right to choose an out of network physical therapist for the treatment they need.
- CMS.gov. Medicare Benefit Policy Manual. Chapter 15, Covered Medical and Other Health Services, Section 40.4 (pg 25). https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf
- CMS.gov. Medicare Benefit Policy Manual. Chapter 15, Covered Medical and Other Health Services, Section 40. (pg 23). https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf
- Carter, J. PT, DPT, Medicare and Cash-Pay Physical Therapy A Quick Start Guide to the Regulations on Taking Private Payment from Medicare Beneficiaries. 2015 Carter Physiotherapy PLLC.