You finally muster up the courage to call and schedule your first pelvic floor therapy appointment. Maybe you’ve been in pain for quite some time… or you thought leaking was just to be expected after having a baby until a friend told you otherwise. You’ve been settling into your new role as “Mom” and it’s finally time to carve out space for yourself to address these aches. Wherever you are in your healing journey - kudos for taking the first step!
NOW sets in some real confusion - finding the right clinic or therapist for YOU. There is a lot to consider: scheduling, finances, etc. When it comes down to it - you want to feel better quickly and efficiently. Finding a therapist you connect with is a major plus too! We’ve listed some important questions to ask when shopping around (as well as some pros/cons)
1. “How long is each session?”
Typical pelvic floor therapy frequency is 1x/week and the standard physical therapy appointment is 45-60 minutes. This allows time to catch up on the last week, assess and perform any manual therapy, go through any necessary and beneficial exercises and review your home exercise program. NOTE: home exercise programs are stretches/exercises, bladder and bowel recommendations or any education given by the therapist for the patient to continue with at home in between your sessions. One hour a week with the therapist is only one piece of the puzzle. Your therapist’s job is to guide you in your healing process and educate you on what to do outside of the clinic for lasting impact.
2. “How much of that session is one-on-one with the therapist?”
This is a big one. Ideally, in our perfect world, patients work with the doctor of physical therapy throughout their session to continually assess movement patterns, response to exercise and areas of weakness to address. Pelvic floor therapy is unique in that it does often include internal assessment and treatment which can be time consuming depending on what is discovered. Symptoms of bladder, bowel and sexual dysfunction are intimate and can be highly sensitive. A well rounded pelvic therapist wears a lot of hats when it comes to treatment: bowel/bladder management, orthopedic assessment, pelvic floor, visceral (organ) mobilization, posture, biofeedback assessment to name a few. It is industry standard to be seen for 45-60 minutes one-on-one with your pelvic therapist for this reason. Working in a high flow clinic where you only have 15-20 minutes with the therapist limits the time with which a clinician can evaluate and perform a beneficial treatment for that day **see insurance question**. If you are left to your own devices for the majority of your session, unsure of your exercises and why you are doing them - I would start asking questions.
3. “Will I see the same therapist each time?”
A team approach definitely has its pros and cons. It can be beneficial to have two perspectives to assess your progress and in the standard outpatient orthopedic setting, it is not uncommon to see multiple therapists due to scheduling conflicts, therapist vacation time and sick days. A significant lapse in care, whether pelvic therapy or an acute post-operative condition, can affect progress and delay healing. As we mentioned, pelvic floor therapy is intimate. You share details about pelvic pain, sexual history, bowel habits and any past trauma. There are clinics where you may see 1-2 therapists so as to not be tied to one therapist's schedule and that is OKAY as long as you are comfortable with that! There is not one right answer when it comes to clinic management and scheduling but BOTTOM LINE: you should know who is treating you that day before you come in and consent to treatment with that therapist.
4. “Do you take my insurance?”
This is hands down the toughest question to answer - especially if it precedes the prior questions. There are excellent pelvic therapists in all healthcare settings - in network, hospital based, private practice, concierge, cash pay. I repeat: THERE ARE WONDERFUL, QUALIFIED THERAPISTS WHO WORK IN ALL THERAPY SETTINGS. Here’s the breakdown:
In Network/Corporate: I group the hospital based/corporate with in-network because it is very unlikely that a small business can afford to (or have the ability to) be in-network with insurance. WHY? It is no secret that over time, premiums go up and reimbursement goes down. If you are contracted with an insurance company the providers have next to no say in the matter. The result? A very tricky numbers game. It may take an in-network practice 3-5 patients per therapist for that hour to generate what one self-pay patient may be charged. What does this mean? Less time for assessment, manual therapy and monitoring from your therapist. Instead of 60 minutes of quality treatment time you may have only 15-20 minutes to update your therapist on the last week AND to be treated. The remaining 40 minutes are stretches and exercises that you could probably do on your own at home. There are also settings where, due to time constraints and productivity demands, internal treatment and assessment is not part of the pelvic therapy program. This is why the aforementioned questions could help in deciding which clinic is right for you.
Out of Network: These are most likely small practices and therapist owned. Out of Network benefits vary from plan to plan and most practices who take insurance could verify your benefits on your behalf. Similar to In-Network, if you have a deductible remaining you will be responsible for the cash rate until that deductible has been met. Practices with a billing team should be able to submit to insurance on your behalf for reimbursement. Depending on coverage, the clinic will let you know what co-insurance you would be responsible for. There are many practices who take insurance (out of network) who are IN NETWORK with Medicare. There still are Out Of Network practices who schedule 2 patients for pelvic floor therapy on the hour because of volume which is why it is still beneficial to ask how long you’ll be working with your therapist each session.
Cash based: Working with insurance is time consuming and stressful. It requires a team for billing, authorizing visits and integrated (usually more expensive) documentation systems to streamline the billing process. At the end of the day, when insurance deems that the patient’s progress has “plateaued” or is no longer medically necessary, they stop covering visits. In the cash model, both the patient and practitioner have autonomy. You and your therapist can decide a plan of care together that both fits your budget and needs. Even more-so, without the hassle and time it takes to go through insurance, your therapist can better focus on your care and goals. The obvious hurdle here is the financial piece that falls onto the patient, but patients who are diligent with their home exercise program can be seen weekly or every other week and benefit from less frequent sessions that encompass more one on one time with the doctor of physical therapy.
We hope these questions help guide you to the right clinic/therapist for you and give you an idea of the different therapy models and how they operate. Looking for a pelvic therapist near you? Check out www.pelvicrehab.com for a directory or reach out to us for assistance!
Health & Happiness,
Dr. Carly and Dr. Katie