The Struggle for Choice in Physical Therapy

My overarching goal as a physical therapist is to help as many people as I can. Physical Therapy is an incredible form of medicine where people heal through harnessing their own body’s power. My life goal is to positively impact as many people as I can through physical therapy. Why then, can I not accept Medicare patients?

This comes down to the Social Security Act’s Mandatory Claims Submission rule which makes it illegal, UNDER FEDERAL LAW, for a physical therapist to collect direct payment from a Medicare beneficiary for  any service that is covered by Medicare. This law applies to all Physical Therapy Clinics despite their relationship with Medicare. So, even a mobile physical therapy clinic like Radix that is out-of-network with all insurances (including Medicare), cannot accept payment from a Medicare beneficiary if that service could be covered by Medicare at another clinic. 

It is wonderful that Medicare covers Physical Therapy services for its beneficiaries as, in my opinion, this becomes an essential medical investment for everyone as they age. However, for those that have Medicare, they lose their freedom of choice for the type of provider they want to see and the type of care they want to receive. Even if the patient wants to pay with their own money out of pocket, it is illegal to provide them care because of the Mandatory Claims Submission Rule. Strangely enough, this law only applies to physical therapists as they are the only health care providers not allowed to opt-out of Medicare. Physicians and other healthcare providers (PA’s, RN’s etc.) may choose to opt-out of Medicare. Efforts are being made to change this rule for physical therapists, however little progress is being made. 

For now, Radix Movement Medicine will continue to follow the law and not provide physical therapy services for Medicare beneficiaries to remain compliant with the the Mandatory Claims Submission Rule.If you feel as strongly as I do that becoming a Medicare beneficiary results in losing your freedom to choose your provider and the healthcare you want, please contact your congressman or senator to demand that this rule be changed so that physical therapists can legally opt out of Medicare. The contact information for your congressman can be found at www.house.gov while the information for your senator can be found at www.senate.gov . 

Radix Movement Medicine only offers mobile physical therapy and mobile massage (therapeutic bodywork) in Helena, MT. Therefore I have provided the information for Montana’s congressional delegation below:

John Tester: 

311 Hart Senate Office Building

Washington, DC 20510-2604

202-224-2644

FAX: 202-224-8594

Steve Daines:

320 Hart Senate Office Building

Washington, DC 20510-2604

202-224-2651

FAX: 202-224-9412

Matt Rosendale:

1037 Longworth House Office Building

Washington, DC 20515

202-225-3211

Ryan Zinke:

512 Cannon House Office Building

Washington, DC 20515-2601

202-225-5628

If you are a Medicare recipient and are still interested in receiving personalized care from Radix Movement Medicine, we do offer personal training sessions which we can offer to all people regardless of medical coverage.

-Chris Shafer PT, DPT, OCS

Physical Therapist Helena, Montana