Can PT notes affect coverage?
My surgeon's office recommended completing physical therapy to demonstrate that I have tried all conservative options prior to opting for surgery. This may be a silly question (or perhaps I'm paranoid) but has anyone's positive notes from physical therapy actually caused issues with your insurance covering your reduction?
I completed around 16 or 17 PT sessions. My initial notes indicated my pain level, pain progressing throughout the day, etc. PT did help me develop some more strength/range of motion in my back and neck BUT as expected, I am still dealing with the same aches and pains as my day progresses. Instead of pain popping up 30 minutes after standing, it's delayed to about 45-60 minutes since completing PT. Also, all of my PT sessions were completed in the morning which is when I am feeling my best.
Here's my concern.... the surgeon's office would like to include all PT session notes when they submit to my insurer after my reduction. My last few sessions indicate my pain level is minimal, I am making great progress, etc. Could these positive notes actually backfire? I'm worried my insurer will say... "see you just need to continue these conservative therapies and don't really need a reduction." On a positive note, I am seeing in my PT discharge paperwork that pain is 5/10 and functional status of carrying, childcare and headaches are all noted as "increasing pain as day progresses."
Does insurance even care about what's in the notes or are they more concerned that you did in fact try alternatives prior to opting for surgery? I should note my insurance's decision on coverage is made post-operatively so that is definitely adding to my paranoia about coverage being denied.