Momentum around better insurer coverage of physical therapy continues to build at UnitedHealthcare (UHC), which announced that it’s moving ahead to expand a pilot project that waives copays and deductibles for 3 physical therapy sessions for patients with new-onset low back pain (LBP). The pilot follows a multiyear collaboration between APTA, OptumLabs®, and UHC.
The program is targeted at UHC enrollees in employer-sponsored plans who experience new-onset LBP and seek care from an outpatient in-network provider. The program fully covers up to 3 visits to a physical therapist (PT) or chiropractor in addition to visits normally covered. When the program was rolled out in June, it was limited to plans sponsored by employers of more than 50 employees in Florida, George, Connecticut, North Carolina, and New York. The expanded pilot, which begins January 1, 2020, will extend to self-funded plans with 2 to 50 employees in Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia.
Thanks in part to expert input from APTA, beneficiaries of UnitedHealthCare (UHC) who are nonambulatory and can benefit from stationary, mobile, or active standing systems may have the cost of the system covered by their insurance. UHC has reversed its medical policy on covering the costs of standing systems (.pdf) after asking for and receiving recommendations from APTA. The new policy became effective December 1, 2015.
Commercial payers such as UHC periodically ask professional societies to provide evidence-based guidance during reviews of their coverage policies, to ensure that policies are comprehensive, accurate, and up-to-date. APTA pulled together subject matter experts who presented evidence to UHC’s Assessment Committee earlier this year; that presentation contributed to UHC changing its stance on the medical necessity of standing systems for patients who meet certain criteria. The evidence showed that enabling these patients to maintain an upright posture can increase their range of motion, reduce swelling, decrease spasticity, prevent pressure sores, improve bowel and bladder function, and maintain bone density, muscle strength, and cardiovascular endurance. Not only can these and other benefits improve the patient’s quality of life, they can reduce or avoid costly medical procedures.