Do you have the feeling or expect that Physical Therapy should be covered by your insurance?
Physical therapy providers are starting to identify some very good reasons why involving your insurance may NOT be in your best interest!
Just like filing an auto insurance claim for damage that doesn’t meet your deductible – it is often best to forego involving your insurance and just pay out of pocket. There is no need to inform your car insurance that there was any damage and risk them increasing your premiums the next time your policy renews. It is the same with filing a health insurance claim. Filing a small claim for physical therapy can have negative complications and unintended consequences. Especially when you can get diagnosed in 2-4 visit at Nick Rinard Physical Therapy, and get good results soon after that, it is better to not have your insurance medaling in your physical therapy affairs by questioning whether you “deserve” physical therapy or not.
Health insurance companies are demanding more and more that patients meet certain criteria, through one-size-fits-none measurements to either deny you care, or begrudgingly agree to authorize just a limited number of visits. This is insulting to your legitimate pain, and disrespectful of your medical providers who should be the only ones deciding if you need care or not. Also, your insurance reserves the right to determine – even after the fact – that your care is/was not “medically necessary” and deny your claims leaving you with an unforeseeable bill. This really is unethical and undermines your relationship with your provider. Also, insurance companies are increasing your cost of care to save themselves money with patient portions closer and closer to the total bill. You, the patient, are better off just paying at time of service at our clinic and not bothering with the extra headache, expense, and disrespectful treatment associated with filing insurance claims – even though you are totally legitimate!
Nick Rinard Physical Therapy’ wants to save you money. Our pay at time of service rate eliminates billing uncertainties from insurance companies. We are making visits more affordable and getting better health outcomes for patients. Advantages to paying at time of service include that patients get uninterrupted service, higher quality care they can trust, hassle-free billing, and no surprise bills at the end. It really is a win – win for both providers and patients for those with high deductibles, who want care out-of-network, who are self-employed, self-insured, expired PIPs and for people who have health savings accounts.
Now is the time to stop insurance companies from unethically pretending to be medical providers and payment specialists that do not have the patients’ best interest at heart. We are your providers working for you! It is our oath to get you results, free of pain and back to living life… We know health insurance companies cannot promise the same.
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The case study I would like to share with you today is only the second hip derangement of this type that I have seen. “Jim” was a 55 year old male who presented with right hip pain that started for no apparent reason 5-6 months prior to coming to physical therapy. He said the pain was provoked only when he was walking, but it occurred consistently at a distance of about 50 to 100 yards. Often it was so painful he could not continue walking. Jim figured out that changing his right foot position enabled him to walk a little further, albeit slowly, and then he could resume normal walking for another 50 yards or so. He would change the foot position by stepping partway onto a curb or raised ground such that the outer edge of his foot was tilted up (eversion, as we therapists call it), and then he would angle his right knee inwardly. That was the only way he had found to improve walking, but the hip just would not stay better.
In desperation, Jim said he had looked online and tried numerous “hip exercises” without any relief. He consulted his doctor, who recommended MDT, which we do here at Nick Rinard Physical Therapy.
Assessment
The mechanical assessment was positive for only two findings: limited and painful hip motion into flexion (folding the knee to chest), and weak and painful testing of hamstring resistance. The protocol for ruling out a joint derangement is to repeat motions to determine if the baselines change. The question is which motion to repeat. One can move either into the most painful direction, go the opposite direction, or check rotations. I chose to go into the most painful direction, in this case, flexion. But before testing I wanted to establish how far Jim could walk in the clinic before his pain started. By the time he walked one length of the hallway and back, he reported pain. I then instructed Jim to bend his knee to chest (compressing the groin) repeatedly and after 20 to 30 times. It produced his familiar pain initially, then the pain abolished and his motion increased. I tested walking after that and Jim said there was no pain even after walking 3 lengths up and back through the hallway! I gave Jim his exercises and scheduled him for 2 days later.
Progress
When Jim returned he reported that he could walk longer distances without the pain starting, however, he still got to the point where he had to modify his foot position in order to continue. I knew we were on the right track, and the next step in treating a joint derangement is to progress forces. I did this manually by applying over-pressure, and instructed Jim to do it in standing by folding his chest down to his knee with it supported on a bench or chair. By the next visit, Jim reported that this had worked very well and he had not experienced any pain at all! So, the derangement was reduced and I needed to wean him off the home exercises to see if it would return or not. I gave him the weaning program and asked to see him back in 2 weeks.
Pain Free
After 2 weeks, Jim came back reporting that he had been able to walk unlimited distances! He resumed walking his dog, going on walks for exercise, and walking wherever, and whenever he wanted. He reported his longest walk lasted 4.5 hours. He said there was no return of the original hip pain from which he had suffered for months. However, on his last two walks, he had started noticing a new hip pain, this time in the front, not on the sides. I re-checked his baselines and neither flexion motion nor resisted hamstrings were painful. That meant it could not be a re-derangement. Resisted hip flexion was painful, and that was new. I concluded that his sudden ability to walk pain-free resulted in his over-doing it. Jim had increased walking too fast and gotten a minor tendonitis. That was easy to treat, and by his next visit, Jim was pain-free again and able to progress walking, though this time more gradually, which was safer.
Successful Treatment
Jim’s hip treatment was obviously a success. It took only 4 visits. This hip derangement was unique because the direction that reduced it (flexion); I have only seen one other hip derangement require flexion to reduce it. The fact that Jim resumed normal activity too fast is typical of reduced derangements – the patient feels so good that they over do it. Luckily in Jim’s case, we found the new problem and fixed it just as fast as we found and fixed his chronic hip pain.
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Nick Rinard Physical Therapy is back from the long Memorial Day weekend– getting patients results.
If you are in pain- let us help you get rid of what ails you before the first days of summer!
“Bi-lateral flank pain. This issue does not appear to be structural, but Nick helped treat mid-to-upper back pain which was also present. I feel I have the tools and techniques to self-treat this and prevent future flare-ups. Thanks!”
John
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Medication, surgery and physical therapy.
Out of the 3 – Physical Therapy is the first road to take.
- Surgery is not a cure all when it comes to back pain.
- Physical therapy restores movement, function and quality of life.
- Physical therapy is cost saving over medications and surgery.
- Injuries heal quicker with physical therapy.
- Medications are just a quick fix.
- Over the counter medicines have negative consequences with long term use.
- Physical therapy helps manage chronic pain for life.
- Physical therapy manages the effects of arthritis.
- Physical therapy prevents joint pain and instabilities.
- No risk profile for physical therapy.
- Physical therapy is totally reversible and no toxicity.
- Physical therapy is the most organic holistic approach that exists.
- No unknown ingredients.
“Severe back pain/herniated disc.
PT allowed me to avoid cortisone injection or surgery.
Initial progress was spot on.
I owe a debt of gratitude to Nick.
Thank you!
I am fully recovered.”
Brian
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By Krissy Brown
20 Feb, 2025
Clinical Case of the Week, Exercise
arm pain, Best physical therapy, Mechanical Diagnosis and Therapies, misdiagnosed, neck pain, Nick Rinard, pain, results, sensitivity in fingers, Thoracic outlet syndrome, TOS
If you are experiencing pain in your neck, shoulders, arms and sensitivity in your fingers it may be thoracic outlet syndrome (TOS).
Get your accurate diagnosis today at Nick Rinard Physical Therapy.
“I experienced numbness in my pinkie and ring finger on both hands.
I had shoulder pain, especially when doing chest exercises.
Thoracic Outlet Syndrome.
The numbness in my finger has gotten better.
My shoulder pain is gone.
I can do chest exercises now without pain.”
Gordon
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If you have moved out of state Nick Rinard Physical Therapy offers telehealth that gets great results, but if you find yourself with a condition that needs in-person visits, here are some questions you might want to ask when looking for a physical therapist.
Is the PT known among patients and providers for getting the best results in the fewest visits?
Does the PT prioritize teaching the patient how to actively self-treat rather than provide a lot of passive treatment to the patient?
Is the PT disciplined in using evidence based care and applying logic to their assessments to find the most likely source of the problem and treat it with the simplest intervention possible?
Is the PT certified in MDT at a minimum?
Has the PT been successfully practicing at the above level for 20+ years?
Does the PT have a lot of patients who choose to return to them for their other issues?
Has the PT taught the methodology to other PTs?
Does the PT put their patients’ outcomes above their own ego and ambition?
Is the PT quick to refer out to another, more appropriate practitioner as soon as the patient fails to show improvement?
The list could go on.
Nick Rinard, Owner, Physical Therapist
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“Thank you so much for your excellent care.
Over the years, I have had treatment with several physical therapists and Katie has done me more good than all of them combined.
Much appreciated and highly recommended.”
Cathy
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