How to get your health insurance to pay for a bike fitting session.
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Guys, stop implying that PTs billing for bike fits is insurance fraud. Trust me, I deal with PT billing all day. There are hundreds of people at every carrier that do nothing but pour over HCFA-1500s and match the coding to medical records before payment. If they don't want to pay for a bike fit, they won't. If they do, they know what they're being billed for.
There are lots of PT/sports orthos that will provide services to runners like custom orthotic fittings and stride analysis. That's no different than a therapist checking your positioning on a bike. It's not like the insurance company is paying for a new stem and saddle.
Last edited by Dan333SP; 11-04-16 at 07:27 AM.
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I know two people who have had bike fits covered by their insurance (associated with injury & rehab) by an in-plan provider. In both cases, the fit was done by Dr. Max Testa. He is a local doctor, but maybe you've heard of him. I imagine appointment wait times can be a bit long since he spends some time working with Team BMC. https://www.maxtestatraining.com/asse...consultations/
Last edited by Clipped_in; 11-04-16 at 07:44 AM.
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#58
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Having your saddle too high keeps the foot plantarflexed (toe pointed down), causing constant contraction of the calf muscles.
Lowering your seat and making sure that your cleats aren't pushed all the way forward towards the toe will help to even out what muscles you're using to pedal.
Allowing the foot to dorsiflex (toe pointed up) during the bottom portion of the pedal stroke can ease the tension on the Achilles, allowing the tendon to have needed periods of rest.
Just in case your insurance says "no".
Lowering your seat and making sure that your cleats aren't pushed all the way forward towards the toe will help to even out what muscles you're using to pedal.
Allowing the foot to dorsiflex (toe pointed up) during the bottom portion of the pedal stroke can ease the tension on the Achilles, allowing the tendon to have needed periods of rest.
Just in case your insurance says "no".
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#61
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It's hard to convince health insurance to pay for a procedure/service that would improve the safety and wellness of one's "hobby", or just simply to prevent one from hurting oneself by conducting such a hobby, even though in certain cases it might save the insurance company money in the long run.
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Insurance and Reimbursement Regarding Bike Fit Erik Moen 2304
Guys, stop implying that PTs billing for bike fits is insurance fraud. Trust me, I deal with PT billing all day. There are hundreds of people at every carrier that do nothing but pour over HCFA-1500s and match the coding to medical records before payment. If they don't want to pay for a bike fit, they won't. If they do, they know what they're being billed for.
There are lots of PT/sports orthos that will provide services to runners like custom orthotic fittings and stride analysis. That's no different than a therapist checking your positioning on a bike. It's not like the insurance company is paying for a new stem and saddle.
Guys, stop implying that PTs billing for bike fits is insurance fraud. Trust me, I deal with PT billing all day. There are hundreds of people at every carrier that do nothing but pour over HCFA-1500s and match the coding to medical records before payment. If they don't want to pay for a bike fit, they won't. If they do, they know what they're being billed for.
There are lots of PT/sports orthos that will provide services to runners like custom orthotic fittings and stride analysis. That's no different than a therapist checking your positioning on a bike. It's not like the insurance company is paying for a new stem and saddle.
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Fair enough, others were labeling it potential fraud or at least deceiving the insurers.
They could use a few different fairly open-ended CPT codes for billing, it's up to the bill reviewers to match the time/activities to the coding.
I actually have a friend who just finished PT school and is an avid mountain biker, I'll ask her whether they've ever billed insurance for anything involving a fitting.
They could use a few different fairly open-ended CPT codes for billing, it's up to the bill reviewers to match the time/activities to the coding.
I actually have a friend who just finished PT school and is an avid mountain biker, I'll ask her whether they've ever billed insurance for anything involving a fitting.
#64
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An older coworker of mine has his bedroom recreation blue pills covered on the same insurance I have...
Just saying!
Just saying!
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I've had 2 fittings covered by my insurance. Both were PT's and that also did bike fittings. My last one a few months back was done by a PT who was a master fitter from Specialized.
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Fair enough, others were labeling it potential fraud or at least deceiving the insurers.
They could use a few different fairly open-ended CPT codes for billing, it's up to the bill reviewers to match the time/activities to the coding.
I actually have a friend who just finished PT school and is an avid mountain biker, I'll ask her whether they've ever billed insurance for anything involving a fitting.
They could use a few different fairly open-ended CPT codes for billing, it's up to the bill reviewers to match the time/activities to the coding.
I actually have a friend who just finished PT school and is an avid mountain biker, I'll ask her whether they've ever billed insurance for anything involving a fitting.
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Late to the party... someone mentioned medical billing codes... looks like it might fall under Physical Rehabilitation (assuming you are a patient undergoing physical therapy for a known medical condition; 2016/17 ICD-10-PCS Codes F00-F0F : Rehabilitation).
Please also keep in mind that not every cyclist is a weekend warrior cat 5 doing this for fun; some commute to and from their jobs on a bicycle or ride bicycles as part of their jobs (messengers/delivery people, for example), so I can totally see this being a justified medical procedure.
Please also keep in mind that not every cyclist is a weekend warrior cat 5 doing this for fun; some commute to and from their jobs on a bicycle or ride bicycles as part of their jobs (messengers/delivery people, for example), so I can totally see this being a justified medical procedure.
Last edited by tFUnK; 11-06-16 at 12:33 AM.
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My cycling has caused me sciatica due to a yet be investigated fit issue (can't ride, no pt bike fitter near me that I know of)
This has been ongoing for 2 months and counting.
3 PCP visits.
3x weekly pt over 6 weeks
1 to 3x weekly Chiro visits over 3 weeks
1 Ortho visit
3 prescription fills
3 XRs
MRI in pre-auth
And counting...
Once this is fixed, damn straight I'm back on my bike. Hopefully moving the seat up a little will help.
I have no idea why anyone would cheat the system and abuse their ins company by ballooning their hobby that keeps them fit into a health issue.
This has been ongoing for 2 months and counting.
3 PCP visits.
3x weekly pt over 6 weeks
1 to 3x weekly Chiro visits over 3 weeks
1 Ortho visit
3 prescription fills
3 XRs
MRI in pre-auth
And counting...
Once this is fixed, damn straight I'm back on my bike. Hopefully moving the seat up a little will help.
I have no idea why anyone would cheat the system and abuse their ins company by ballooning their hobby that keeps them fit into a health issue.
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My cycling has caused me sciatica due to a yet be investigated fit issue (can't ride, no pt bike fitter near me that I know of)
This has been ongoing for 2 months and counting.
3 PCP visits.
3x weekly pt over 6 weeks
1 to 3x weekly Chiro visits over 3 weeks
1 Ortho visit
3 prescription fills
3 XRs
MRI in pre-auth
And counting...
Once this is fixed, damn straight I'm back on my bike. Hopefully moving the seat up a little will help.
I have no idea why anyone would cheat the system and abuse their ins company by ballooning their hobby that keeps them fit into a health issue.
This has been ongoing for 2 months and counting.
3 PCP visits.
3x weekly pt over 6 weeks
1 to 3x weekly Chiro visits over 3 weeks
1 Ortho visit
3 prescription fills
3 XRs
MRI in pre-auth
And counting...
Once this is fixed, damn straight I'm back on my bike. Hopefully moving the seat up a little will help.
I have no idea why anyone would cheat the system and abuse their ins company by ballooning their hobby that keeps them fit into a health issue.
I developed a sciatica issue last season that carried into this season. It was excruciating at times while on the bike. Specific stretches help, massage therapy helped but it was not going away. By chance I found this summer that a flat saddle takes the pressure off of the nerve. I had been riding a Prologo Scratch series, it is their round design.
I rebuilt and converted an 80's ATB into a drop bar big tire CX of sorts. I used the flat OE saddle that came on my Orbea, at first thought until I found something else. The more I rode my conversion, I realized I wasn't having sciatica issues. I would take the Orbea out and sure enough in a few miles in my issue flared up again.
This may be a coincidence for me but it is working. So well that I am going back to a flat saddle on the Orbea.
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Ask your primary care physician, if he(she) is not part of a big group like Kaiser Permanente. X-rays, blood tests, etc. get over done. Patient goes in to a clinic or E.R. and gets a battery of tests. Then next visit, patients goes to a different facility and gets the similar battery of tests. Not bothering to tell the personnel at the second facility that the test results are available from the first facility.
#74
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How surreal all this is to read from a country with state-mandated universal insurance. People who can't afford inflated insurance prices (so they go to the E.R.) get blamed for the inflated medical costs while the insurance companies laugh all the way to the bank.
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I know this is wildly out of character for me, but...
Health care costs and insurance premiums can be discussed in the politics & religion forum.
OP's question was about whether some health carriers will pay for a bike fit. We've answered that question. Some will pay for it if it's through a PT that provides these services and is in treatment of an injury.
Complaining about whether something is "fleecing" the insurers or using the ER if you're uninsured is totally irrelevant to his topic.
On that note: ****!
Health care costs and insurance premiums can be discussed in the politics & religion forum.
OP's question was about whether some health carriers will pay for a bike fit. We've answered that question. Some will pay for it if it's through a PT that provides these services and is in treatment of an injury.
Complaining about whether something is "fleecing" the insurers or using the ER if you're uninsured is totally irrelevant to his topic.
On that note: ****!