will workers compensation pay for a gym membership for physical therapy?

Question

I have "hardware" holding my spine together as a result from a fall off of a ladder. I have lifetime medical for my back and went to my w/c dr. for a Rx for gym membership to resume PT. I want to be able to swim laps as well as go to the yoga classes. He says they won't cover it.

Answer 1

It is highly doubtful that they will cover it. Release to gym should only come after physical therapy has been complete as is no longer deemed "skilled." In other words, once you have completed PT, or perhaps during your PT, there may be a recommended home program from your therapist. These should be exercises that do not require the skill of a physical therapist to be present while you complete them (ie, you can perform them as directed by the therapist). However, if your therapist recommends that you complete a certain set of exercises that would require a gym membership, then, it is POSSIBLE that a gym membership would be medically necessary. It would take a lot of arguing, but I would say it is possible if done with the consent of the PT and physician. Yet, usually at this point, most people are released to return to work, or if no further benefit is possible, then usually a settlement is made...no longer placing them under the coverage of workman's compensation...I suppose it's a catch 22.

I would speak to your therapist about it as a letter of medical necessity would need input from the PT.

Answer 2

Going to a gym isn't the same as physical therapy at all. Physical Therapists have years of training so that they can have you move and exercise in ways that will help your particular problem while avoiding futher injury. If your MD feels that PT is necessary, that should be covered. The Physical Therapist will be able to tell you if swimming laps or Yoga are the best activities for you, and they may have other options you hadn't considered. Go to a professional, your back is important!

Answer 3

While physical therapy is covered by most insurance claims, a gym membership is not technically physical therapy. Why? Well for one, a gym instructor is not a licensed physical therapist. Two, yoga is not defined as a form of physical therapy, however, you may be able to cover other alternative forms of treatment such as accupuncture and chiropractic.
Your doctor should be writing you a prescription for PT for a specified number of weeks to help you recover from your injury and surgery. A good PT facility will have water therapy available to you if appropriate.
You are on your own as far as the gym goes.

Answer 4

Get your doctor to order gym membership. If denied, get your lawyer involved if you have one. I just did a couple of weeks of PT and it did not help at all. Also, I was disappointed in the PT assistant. He was trying to work with another patient and myself, plus leaving the room, so it was not like I was being assisted. I am also trying to get approval for gym membership. Remind W.C. that 1 physical therapy session cost as much as a month of many gym memberships.

Answer 5

I'm not sure about a gym membership, but workers comp/health insurance might cover enough visits to a physical therapy clinic where you can work out and use exercise facilities like those in a gym.

Answer 6

You might see about making arrangements with the gym and Workman's comp to allow you to use the pool.