Hello Lisa:
My belief (and it may be wrong!) is that insurance companies never approve
or deny what is appropriate treatment. However, they do PAY for only what
they think is appropriate. They control the market because they control the
money.
Just my opinion... I'm interested to read what other OTnower's think.
Ron
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On 8/28/2001, Lisa M. Dean <[EMAIL PROTECTED]> wrote:
LMD> Dear List,
LMD> 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.
LMD> 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
LMD> 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
LMD> 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.
LMD> 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
LMD> 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
LMD> 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
LMD> 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
LMD> 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
LMD> 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
LMD> use of a physio ball.
LMD> 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
LMD> 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
LMD> from which insurance companies set the standards for how we practice our
respective disciplines.
LMD> What does this list think.
LMD> Lisa
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