Why Out-of-Network Care?

I know. Insurance is boring. But, here is a question I have to address often so hear me out…

Why “In-Network” may not be the cost-effective approach to your baby’s therapy:

analysis blackboard board bubble

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Lil’ Peanuts Physical Therapy was founded with the goal of helping babies and parents when they need it most along with the belief that top-notch, high quality, one-on-one care cannot be rushed, limited, or capped. A child’s quality of life and growth should not be dictated by his insurance company.

Due to new changes in health insurance plans, high deductibles, and costly copays, sometimes just being “in-network” does not mean lower costs for services such as physical, occupational, and speech therapy.

Early intervention is most effective with frequent and consistent treatment sessions in a short amount of time while babies are drastically changing and growing the first few years of life.  These therapy sessions add up. Having to wait months for insurance approval, reimbursement, and referral to in-network therapists, means critical periods of infant development are missed and care time ultimately lengthened, adding even more to total cost for services.   Not to mention, wouldn’t you want to choose who you go to for therapy (based on specialty and experience) rather than wait for insurance approval?

 

full frame shot of eye

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Insurance providers and adjusters are notorious in their tactics to pay as little as possible on claims:  often denying charges, limiting diagnosis codes, delaying payments, and requesting re-evaluations every few visits.  Some may even put limits on the frequency of therapy regardless of how well the baby is progressing.  The entire claims process itself can take months to sort through. This means that instead of just concentrating on providing the most effective evidence-based interventions, a therapist has to spend therapy time every couple visits to run tests on the child and submit proof for why he would benefit from a higher frequency therapy than the once monthly allotted by insurance.

Once again, critical growth and developmental milestones are missed during all this tug and pull with insurance companies: a child who could have fully improved after 8 weekly sessions may end up needing a year of monthly sessions to complete her therapy goals. In baby development, timing, intensity, and frequency of therapy is critical.  I have seen insurance companies deny coverage of consistent therapy for children with diagnoses such as torticollis, cerebral palsy, and spina bifida, which are all well-researched diagnoses.  The benefit of early and frequent physical therapy is well-documented in the scientific community for these conditions!

topless toddler with pants sitting on white surface while looking up

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There has been a recent shift in U.S. healthcare and even primary care providers and medical specialists are making the move to fee-for-service clinics. Private-pay clinics are actually great for therapists AND patients.  Read more here about why the question really should not be ‘Will my insurance cover this?’ but ‘Whom can I trust to give me and my family the best care for my money?’

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Infant skull growth and why the first 6 months is so important.

It has now been more than 6 months since I started working at Cranial Technologies, a cranial remolding orthotics company. Over the past few months, I have gotten to know hundreds of babies. I meet new ones every day with a very specific condition: positional head shape change (plagiocephaly and brachycephaly). This condition can be due to a variety of reasons (to be covered in an upcoming blog). What amazes me is that while the condition has been around since the 1990s and pediatricians have known about it for years, I still meet with new parents every day that had no idea their babies’ heads could change so drastically in such a short period of time.

Many pediatricians do a wonderful job of referring babies to physical therapy or craniofacial specialists before 6 months of age. Yet so many others are waiting until the babies turn one year old, hoping that they would normalize by that point. And in mild cases, they do round out on their own. But for most of the very severe head shape deformities we encounter, the best time to treat is actually before 6 months.

Why? Because newborns have softer skulls that will take time to harden and fuse together as they grow. A majority of their brain growth (and therefore skull growth) happens in the first 6 months of life. This is a time in their life when they are the most susceptible to forces that may change the shape of their head.

I have encountered many frustrated parents who come to us with babies older than 18 months, whose faces and ears are completely out of alignment.  At that point, the helmet is no longer effective to change the shape of a baby’s head.

The best time for treatment with a cranial remolding orthosis and repositioning is between 4-6 months. The baby’s head control is much better at that point. The treatment process is actually much quicker because the baby is changing faster. Beyond 6 months, and head growth slows down significantly. This can be seen in the following infographic. The blue is the newborn head size, the green is how much it grows and changes within the first 6 months, and the yellow is how much it grows for the next 6 months.

infograph

Infant Skull Growth Infograph

 

With such a time-sensitive condition on our hands, if you have any reservations or concerns about your baby’s head shape and head growth, please bring it up with your pediatrician!

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Feeling lucky at work, every single day.

Around 9 months ago, I bid a tearful goodbye to a job I loved in Chicago and moved across the country to be with my husband in Los Angeles. At the time, I was sort of excited about all the new possibilities this sudden break meant in my career. But mostly, I was incredibly heartbroken. I did not want to leave the clientele I had worked so hard to build a relationship with over the past few years.

My path to finding this job I absolutely adored was a tough one. Years of working for hospitals and positions that were just not right for me left me feeling disappointed in our healthcare system and what it means to be a physical therapist in that system. I wasn’t just feeling burnt out. I started to question whether or not I even chose the right field. I had brochures from MBA schools and Art schools all piled up on my table, until I finally found a job that felt… just right. Over the next 3 years’ time, I watched hundreds of babies and children grow up and thrive. And I thrived too. When I left, I cried because I worried that I would never find a job I loved so much, with the clientele that I always knew I was meant to be helping.

As I was leaving Chicago, I already had an offer from a company I worked closely with in the past. I loved them and they loved me. I would get to work with babies and only babies, my favorite population. It was a very niche field, so niche that my peers looked down on the idea and warned me that it might get boring. I wanted the job but I also, in a way, didn’t want to disappoint my peers. I didn’t want other therapists to think that I came this far just to “settle” in to an “easy” job.   So in the month I had off from work, I stalled on making a decision. I attended conferences, I spoke with therapists in the school system, I toyed with the idea of working for a big children’s hospital again, I reached out to universities and researchers, I thought about maybe finally going into art. But what I realized then was that I had to make the choice that feels right for me, even if everyone else turned their noses up at the idea. I also realized that one decision does not lock me in to only one path. One decision was not going to close the door on all the other possibilities. The people I met and spoke with who went the path that I thought I wanted to go on (climb that career ladder, work for that large hospital system, and spend years in that laboratory), they were . . . exhausted. And unhappy.

At this one point in my career, I knew what I wanted. I wanted to continue to build relationships with people. I wanted to change lives for the better and be a healthcare professional people can count on and trust. And I wanted to know my clients. I wanted them to know that they can call me, even months and years after I have seen their kiddo. The professional relationship for me did not end when they walked out of the clinic. Babies grow up. Toddlers start school. New questions come up.

Fast forward to the past few months: I love my new job. Los Angeles is growing on me. It gets hectic some days. I went from having at most 9 clients a day to having 24 on a busy day. I still try hard to connect with people, even those I only meet once. Sometimes, one time is all I need to help them out where they need it. Sure, there are babies I wish I could spend more time with. There are families I wish I could help more than time allows. And that is why I started my own company on the side. Working for a niche population didn’t limit me. It revived me. Every day, the babies and parents I meet are helping me figure out how I can give more from my side, with the experience and knowledge I have. Every day, I count myself very lucky to have found a career that gives me so many choices and inspires me to do more.

Just yesterday, an old client reached out just to say hello and update me on their lives. I know I am lucky to wake up to an email like that instead of work emails that immediately make one dread the day ahead. Another parent told me today that they feel so lucky they have me to help them navigate their first year with a baby with special needs. I am the lucky one, I tell them. I am lucky that I have learned the valuable lessons from working for companies that were and were not right for me. I am lucky that I have the support from my clients and that they can be honest with me in terms of what kind of care they want from their healthcare providers.

No, I didn’t settle. I worked hard to build relationships with the people around me. They gave me an opportunity. I saw all the possibilities that came with something new. And I took it. I still count myself lucky of course. I am so lucky to be doing something I love. Every single day.

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What happens during a PT session?

Everyday, I evaluate new babies I meet on their head shapes, muscle strengths, and gross motor skills. The other day, a parent filmed part of my session. While I cannot provide traditional physical therapy interventions at my day job (where we make helmets for babies with misshapen heads), I just started my very own physical therapy company (http://www.lilpeanutsphysicaltherapy.com).  This way, I can spend more time with babies who need more intense exercises at home to address their physical skills or neuromuscular limitations. Here is a sample of what I may show parents from time to time. As you can see, most babies do not enjoy getting stretches, but the more we do it the more comfortable they’ll be.  Enjoy!

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What is Pediatric Physical Therapy

Brief description of pediatric PT in an outpatient clinic setting with relatively high functioning clientele. Starring yours truly.

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5 common misconceptions about pediatric PT

Most of the parents I encounter on a daily basis had no idea baby physical therapy existed as a resource for them. Some were sent straight from a pediatrician’s check-up. Some were redirected by teachers they trust. Some found physical therapy after extensive internet research on ways to help their children beyond a regular afterschool program.  I have met parents who consider physical therapists doctors, and I have met parents who equate us to gym teachers. PhotoGrid_1449779678278

Indeed, we are clinicians, teachers, cheerleaders, and so much more. Physical therapists work with children on many different conditions that affect their ability to interact with their environment, whether the root cause is medical, environmental, or developmental.  The most rewarding part of my job is that I help children, and parents, succeed. Over the years, the most futile cases I have encounters and the most frustrating situations I have worked with, have been with parents who come into their physical therapy programs with the below preconceived notions.  Do any of these sound familiar?

Myth 1:

If my baby cries during her session, physical therapy is not right for her.

Here is the simple truth: physical rehabilitation is going to be hard: for the most easy-going of children or for the most stoic of adults.  And it is especially tough for babies, because they don’t communicate the way we do. But here is the other thing… We know that and we have been trained to make rehab fun. That doesn’t mean the first few times children meet us are going to be all giggles and bubbles. Part of our job as PTs is to figure out what is challenging for children with developmental difficulties, and then make it an easier task for them. Some children warm up within 10 minutes of meeting us, and some will cry for their first 3 weeks. We will always always monitor their pain levels, their activity tolerance, and their physiological responses.  We are health professionals after all. Most of us have extensive backgrounds in childhood, development, biology, and psychology. We take our professions very seriously, despite running around in our socks and making funny faces all day. The one thing we want most is for children to enjoy their physical therapy sessions, so they come back frequently and make necessary gains. We are not trainers you see on TV, yelling at our clients. Our motto really isn’t “no pain, no gain.” It breaks our hearts too when babies cry, but we do keep our goals for them in mind. All we ask of parents is to be patient and supportive of the process, which leads us to the next common misunderstanding we encounter.

Myth 2:

The physical therapist can fix whatever the musculoskeletal or development problem is in a month’s time.

I get it. When I go to a healthcare provider, I want them to make whatever I’m dealing with go away, immediately. Parents of today are overloaded with lots of responsibilities, from advancing their careers, maintaining their relationships with other adults, to keeping track of all their own meetings and appointments. Adding their children’s doctor appointments, school schedules, and teacher conferences can be an overwhelming existence.  We know that the most frustrating part about physical therapy (or therapy of any sort) for parents is trying to attend the regular appointments for the period of time required.  Full recovery and successful completion of the physical therapy program takes time.  I confess, I have cancelled physical therapy for myself before, because I was busy and thought I could do it myself. So, we don’t fault parents for wanting us to make changes for their children quickly, with minimal time commitment. But, research has shown time and time again that regular, frequent, and consistent physical therapy sessions shorten recover time and encourage long-term wellbeing overall, for patients of every kind.  Children’s body systems adapt to changes and regular exercise much more quickly than adults. We are constantly monitoring their progress so we can adjust the frequency and intensity of their therapies. Even so, depending on the condition, significant change that is measurable on standardized developmental assessments (for insurance and medical reporting purposes) don’t occur until 3-6 months after onset of therapy. What parents should know is that our ultimate goal is for children to not need us after their therapy programs. We are not out to keep kids in rehab longer than necessary or for all their lives. We want them to become fully independent and functional without us. We want them out of therapy and doing what kids should be doing: playing with their friends and going to school.  So whenever parents ask to stop their child’s therapy after 1 months’ time, I tell them there are things they can do to speed up the recovery process.  Which leads us to misconception number three from parents.

Myth 3:

Parents don’t need to pay attention to the exercises their child does with his physical therapist.

Even during the most rigorous of PT programs, therapists only see children a few times a weeks, for maybe an hour at a time. We spend a major part of our efforts during therapy not just doing exercises with the kids, but also teaching them new skills to incorporate into their daily lives.  Physical therapy is unfortunately not just a pill one can take to make everything better right away. It asks patients and their parents to become active participants in their healthcare.  This is challenging, I don’t doubt that. And with parents being asked to step in during all other hours of the week to become makeshift therapists, teachers, nurses, and everything in between, exercises can fall by the wayside. But this is why we spend a large part of our treatment on educating families as a whole, so everyone takes charge of a child’s recovery, and it’s not left up for one person. A good therapist will take into account everyone’s daily routines, the parent’s struggles, and the children’s interests, to find ways to make things work.  Our job is to help parenting easier for children with injuries, pain, developmental difficulties, and functional challenges.  We are here to listen and provide feedback. We are here as much for the parents as we are for the children, because we know how important family is to therapeutic healing.

Myth 4:

If my pediatrician didn’t recommend physical therapy, my baby doesn’t need it.

Healthcare for children relies heavily on a team approach. Every medical personnel has a specific role and very detailed training for that role. As children meet more and more of their milestones (develop teeth, start walking, learn to read, etc), there are more specialists for parents to take them to (dentists, podiatrists, optometrist, etc).  Most new parents of children with developmental issues learn over the years that a pediatrician cannot cover every aspect of a child’s development. It’s simply an impossible task for the pediatrician, whose main goal is to keep children healthy and free of pathogens. The pediatrician may be their go-to guru for questions early on and serve as a gateway to other providers, but even they get bogged down by the many things they have to pay attention to during routine visits. Many pediatric doctors choose to specialize in certain conditions, just to address the things a pediatrician cannot. In that same vein, what some parents misunderstand is that pediatric physical therapists are movement specialists. We are experts in the way babies, children, and adolescents move, and how their different body systems interact with each other to aid movement. We have been trained in what typical development and alignment, and age-appropriate motor skills look like, feel like, and can accomplish.  Many pediatricians often take the wait-and-see approach with motor delays or alignment because, well, sometimes it’s not life threatening and parents don’t know to be concerned. But physical therapists spend significant amounts of time observing and engaging with our clients to see how they use their body systems in different situations. We are often the first ones to catch the tale tell signs of an underlying medical condition that requires a specialist. We know that abnormal neurological development and mechanical issues show up early and can be addressed before faulty motor patterns affect children’s cognitive, social, and physical development later.  So just because one pediatrician doesn’t think it’s important for a 7 months old to be sitting independently yet, physical therapists know that it is an essential skill in order to crawl, eat, learn to use her hands, refine her vision, develop her sense of balance, and learn to talk. We are the ones who can give new and swamped parents just a few tips to encourage that milestone and build a solid foundation for their child.

Myth 5:

Baby chiropractors are totally the same thing as baby physical therapists.

I am always surprised when parents tell me they are considering consulting a pediatric chiropractor instead of attending regular PT sessions because “they work on the same thing, they don’t require doctor referrals, and are cheaper.”  I cannot reiterate this point enough: baby chiropractors are not healthcare professionals backed by scientifically sound research and the pediatric medical community. Pediatric chiropractic practices is just a term someone with a chiropractic background can use to describe what he does, but it is not a board certified, highly specialized clinician. Most chiropractors actually stay far far away from pediatric practices because their high-velocity spinal manipulations are not recommended on growing soft tissues. Some chiropractors who claim to treat pediatric conditions only attended a weekend course with minimal practical training on actual young patients. Most of the conditions pediatric chiropractors claim to treat by “manual adjustments” or “spinal manipulations” are not only self-limiting conditions, but these techniques are only supported by low-level scientific evidence.  (Please see my previous blog: The truth about pediatric chiropractors).  Pediatric chiropractors have been in the news for numerous incidences of harm and neglect, especially in conditions affecting babies. Some make faulty claims about the frequency and intensity of treatment needed.  The goal of physical therapy is to treat a condition and return a child to his full potential so that he won’t have to come back to therapy as an adult. The goal of chiropractic practice is to keep patients coming back for “regular adjustments.” I have known parents who have taken their perfectly healthy children to a chiropractor once a week from newborn to 6 years of age, just to “maintain proper alignment.” No wonder some insurances refuse to cover chiropractors.

Don’t get me wrong. There are some great chiropractors out there, for various adult conditions that are related to mal-alignment or acute injury. I have known chiropractors who referred out to physical therapy when they’ve reached the limits of their practice. I have known chiropractors who recommended more active participation in exercises from their clients. I have known chiropractors that have partnered with PTs to provide the optimal plan of care.  But, I have also known chiropractors who manipulated babies when they shouldn’t have, and chose to not disclose what exact techniques they used on these clients when asked by other health professionals.

There are many other misconceptions I have heard from parents over the years, but most parents are very open to education on various medical recommendations. I know that many times, parents are just trying to provide the best resources for their children. Finding out one’s child has a developmental delay or is suffering from an injury is definitely tough, especially when resources are limited.  Pediatric physical therapists are here to help. We are not just children’s biggest advocates in their physical wellbeing, we are also mostly here for the parents.

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The 7-minute workout for kids!

The 7-minute workout is an effective high-intensity training for adults. It is also something you can do with your kids on a daily basis. Read here for how to modify this workout for young bodies:

http://nspt4kids.com/parenting/benefits-7-minute-workout-kids/

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