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How to get your health insurance to pay for a bike fitting session.

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Road Cycling “It is by riding a bicycle that you learn the contours of a country best, since you have to sweat up the hills and coast down them. Thus you remember them as they actually are, while in a motor car only a high hill impresses you, and you have no such accurate remembrance of country you have driven through as you gain by riding a bicycle.” -- Ernest Hemingway

How to get your health insurance to pay for a bike fitting session.

Old 11-04-16, 07:13 AM
  #51  
69chevy
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Originally Posted by Dan333SP View Post
I smell a good story here. Details? New thread?
Already started one, it's one you refer to often.
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Old 11-04-16, 07:18 AM
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Originally Posted by Bassmanbob View Post
I'd love to know what CPT code the physical therapist used to get a bike fitting covered.
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.

Last edited by Dan333SP; 11-04-16 at 07:27 AM.
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Old 11-04-16, 07:32 AM
  #53  
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Originally Posted by Dan333SP View Post
It's not like the insurance company is paying for a new stem and saddle.
How can I get the insurance company to pay for those as well as wheels?
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Old 11-04-16, 07:36 AM
  #54  
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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. http://www.maxtestatraining.com/asse...consultations/

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Old 11-04-16, 07:41 AM
  #55  
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Originally Posted by Doug28450 View Post
How can I get the insurance company to pay for those as well as wheels?
Eying up a set of Zipp 454 NSWs, are we?


Even if you plan covers them, why not just pay for them out of your own pocket?
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Old 11-04-16, 07:42 AM
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Originally Posted by Doug28450 View Post
How can I get the insurance company to pay for those as well as wheels?
You can probably get them to cover EPO. That'll help more than wheels.
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Old 11-04-16, 07:44 AM
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Originally Posted by Dan333SP View Post
You can probably get them to cover EPO. That'll help more than wheels.
True, but wheels would look cool.
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Old 11-04-16, 07:45 AM
  #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".
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Old 11-04-16, 07:47 AM
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Originally Posted by doug28450 View Post
true, but wheels used to look cool.
fify. 454 nsfw ftl.
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Old 11-04-16, 07:48 AM
  #60  
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Originally Posted by Doug28450 View Post
True, but wheels would look cool.
As long as your doctor can convince the insurance company that the watts you save can ease the wear and tear on your joints, I would think the wheels might be a medical necessity and should be covered.
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Old 11-04-16, 08:08 AM
  #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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Old 11-04-16, 09:01 AM
  #62  
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Originally Posted by Dan333SP View Post
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.
I didn't mean to imply it was fraud. I just wanted to know what CPT code was used to get it covered. I think it SHOULD be a covered service, considering a good bike fit will prevent many injuries. Insurance companies may or may not see it that way regardless of what I think.
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Old 11-04-16, 09:13 AM
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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.
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Old 11-04-16, 10:28 AM
  #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!
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Old 11-04-16, 11:54 AM
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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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Old 11-04-16, 12:03 PM
  #66  
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Originally Posted by TheRef View Post
An older coworker of mine has his bedroom recreation blue pills covered on the same insurance I have...
But if he injures his, uh, YKW, will the insurance cover things like massage therapy?
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Old 11-04-16, 12:15 PM
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Originally Posted by skoobywrx View Post
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.
How did you find this PT?
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Old 11-04-16, 12:49 PM
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Originally Posted by TheRef View Post
How did you find this PT?
Just a recommendation at a bike show here in Seattle. Basically what you can do, is call/email some fitters and see if they are a qualified PT and if/will charge the fitting to a pt session.
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Old 11-04-16, 07:44 PM
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Originally Posted by Dan333SP View Post
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.
Just went back and looked mine, it was billed as "99205 - Office Visit" for a whooping $456.00...
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Old 11-05-16, 09:23 PM
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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.

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Old 11-08-16, 04:59 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.
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Old 11-08-16, 05:55 AM
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Originally Posted by inspclouseau View Post
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.
What style of saddle are you riding?

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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Old 11-08-16, 07:25 AM
  #73  
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Originally Posted by 69chevy View Post
Why is medical insurance so expensive? People using it for things they don't medically "need" is one reason.
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.
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Old 11-08-16, 08:09 AM
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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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Old 11-08-16, 08:21 AM
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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: ****!
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