Why Is My Surgeon Trying to Tell Me I Dont Need Physical Therapy?

Question by The Bell Jar: Why is my surgeon trying to tell me I dont need physical therapy?
after having 7 screws put into my broken ankle (bimalleolar fracture)?

I have insurance and obviously after a break this bad I need physical therapy, and his assistant called me trying to tell me all I need is to do range of motion exercises at home.

Isn’t that what people WITHOUT insurance do? And only bc they have to?

Best answer:

Answer by mistify
I’d first ask if you are on an HMO or other managed care plan and if your providers are paid under a “capitated rate.” In this type of payment structure, your healthcare providers are paid on a regular basis just to keep you as part of their plan…whether you receive services or not. For instance, a healthcare group might get paid $ 20 a month whether they see you or not. When you DO see them, they don’t get paid anymore than their normal monthly payment. So, in essence, it’s like the “loose” money when they actually have to see you. Providers who are reimbursed under this type of payment structure make more money the less they see their patients (generally speaking…I’m over simplifying it a lot) and, instead, increase the number of visits for patients who are “fee-for service” plans. Providers who see patients who are under “capitated rate” plans will often think more critically about sending someone to a service they may or may not need. I’m not saying this is what’s going on…but it may be a factor in his decision if you have this type of insurance (and note, not all HMO’s are “capitated rate” plans).

However, in the case of bimalleolar fractures, I would say NOT having PT is not completely unusual. Bi-malleolar fractures tend to do much better than tri-malleolar fractures because the tri’s involve not just the fibula and tibia, but also the talus (when the posterior mallolus of the tibia is fracture it often limits movement of the talus)…it’s the talus getting stiff that usually prevents people from getting good movement.

I’m not saying that PT wouldn’t be of benefit to you, but it’s probably not critical either. If your progress appears slow, he can always refer you to PT at that time.

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