Dear List,
I am primarily a lurker on this list but now have a little to contribute in regards to
a possible reimbursement issue. I am an OT who will frequently utilize hippotherapy
as a treatment tool. Hippotherapy is a specialized area much like sensory
integration, hand specialties, etc. In fact the American Hippotherapy Association in
conjunction with AOTA and APTA, have developed a board certification to ensure that
individuals who utilize this highly specialized treatment tool have the appropriate
education and training. SLP's are also able to utilize hippotherapy as a treatment
tool. Being a treatment tool, hippotherapy is in the same category as a swing,
physio ball, scooter boards, etc. except more powerful. Riding skills are not
taught.
Now that the brief background is covered here is the issue. A PT in Maryland has been
utilizing hippotherapy as a treatment tool for many years. she has appropriate
documentation and also includes carry over activities in a traditional therapy room
setting. After years of providing hippot, blue cross and blue shield audited her
private practice and asked for $56,000 back from her. With the backing of AHA, she
went to court and won. In addition, APTA and AOTA wrote letters stating the
utilization of hippotherapy is within the individual practice acts and an appropriate
treatment tool. The court decided Hippotherapy was an appropriate tool to be used by
individuals with the appropriate training. However, after the battle was won, the
decision went be for the state insurance commisioner who over turned the decision,
forcing this PT to pay back the said amount. He Stated that insurance have a right to
dictate to therapists the treatment tools utilized during therapy and !
also stating hippotherapy was experimental. However, if one does the research, one
will find more documentation regarding the benefits of hippotherapy than the use of a
physio ball.
Now for the meat of the issue. When does the insurance industry have the right to
dictate what treatment tools we utilize to achieve functional goals? AHA has since
offered to pay some of the cost for the attorney's during the appeal, however, the
funding is limited. I myself, would like to see AOTA and APTA become more involved.
I would hate to see this court case become the basis from which insurance companies
set the standards for how we practice our respective disciplines.
What does this list think.
Lisa
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