TRICARE Paying Entire Cost of PT Visits Now to Save Money Later

TRICARE, one of the nation's largest insurers, wants their members to get physical therapy for back pain. They think that treating back pain with PT is so important that they're willing to provide PT visits at no cost to their members. That's a huge deal. When's the last time you had an insurance company covering something without sending you a bill?

You probably already know that back pain is common. What you might not know is that the medical system isn't very good at treating it. "Non-drug treatments like physical therapy" are the first treatment recommended for back pain. However, PT isn't usually what is prescribed, so insurance companies and patients often end up spending a lot of money for outcomes that are less than stellar.

For someone with back pain, the path to a physical therapist is usually long and winding. They frequently start at their PCP's office. Instead of the PT referral that current guidelines dictate, they usually get medication, a recommendation for rest, an order for x-rays or an MRI. Next is usually a referral to a specialist. Sometimes the specialist will refer to PT, and sometimes the patient will head back to the PCP to end up with a PT referral. The path can vary, but the end result is usually the same - multiple failed treatments, imaging that's not needed and a delay of weeks or months to get to a physical therapist.

Multiple large studies that looked at the effects of early physical therapy on low back pain show impressive results. One of them was done in 2006 in Seattle by Virginia Mason Health Center. Workers with back pain saw both a physical therapist and physician for their first treatment. Use of MRI dropped by 1/3, people got better faster, missed less work and were more satisfied with their care. The cost savings was so great, that Virgina Mason was losing money on treating back pain and Aetna ended up paying them more for PT treatments because Aetna was saving so much money.

Intel ran a similar program with their employees, getting people with back pain to a PT within 48 hours. With early access, patients completed their care in 21 days, compared with 52 days previously and costs dropped between 10 and 30%. Intel also found more satisfaction with care and a faster return to work.

The data is out there to show that people with back pain should start treatment with a physical therapist, but most don't. TRICARE's pilot program that waives copays for up to three PT visits intends to change that. If successful it will lead to lower costs for both TRICARE and their members while delivering better outcomes in less time for people in pain.

We can help you with your back pain here at Rejuvenate llc. Contact us through or website at RejuvenatePT.net or give us a call at 406-677-7722