Barbara Hundt, of Madison, put it this way: Stand at the side of the pool and the doctor-ordered physical therapy for her broken foot costs her nothing.
Stick that foot in the pool, though, and she’s out $804.
Hundt, 64, broke her left foot and damaged some ligaments May 3 while sightseeing on a trip to Canada.
After some time off both of her feet, her doctor sent her to a physical therapist, who after one session said what she really needed was some time in the pool.
Physical therapy in water provides resistance but without pressure or direct contact with a hard surface, she explained to SOS, and this can speed up recovery and provide more healing per PT session.
“I really did progress. Prior to that I couldn’t even touch it,” she said of the water-based PT.
Hundt said her insurance company, WPS Health Solutions, pre-approved six or eight PT visits, and she assumed that included water PT, given that’s what her in-network physical therapist at UW Health was urging her to get.
“It never dawned on me, nor (on) the PT,” to question whether insurance would cover it, she said.
She was wrong, and in a July 10 statement from the insurer found out she was expected to pay $804 for the two water sessions on June 22 and June 26. One on June 14 on terra firma was covered. Its list price is $320, according to the statement, but cost $227.20 with a “provider discount.”
WPS spokesman Tom Enwright declined to comment on Hundt’s cases when asked about it on Oct. 9. But an Oct. 15 email to Kathleen Held, in the company’s Grievance & Appeals division, and WPS Senior Account Manager Courtney Loos might have shaken something loose.
Hundt said that at about 5 p.m. that day, she got a call from a fourth WPS employee saying the water PT charges would be covered.
“Yesterday was a great day,” she said via email on Oct. 16. “Big Brewer & Packer wins & I’m $804 ahead, thanks to WPS & both of our efforts! I’ve been contacting people since July & think your involvement turned the corner for me.”
According to an Aug. 20 email from Loos and provided by Hundt, Hundt’s policy specifically exempts “aquatic therapy” and “is a standard exclusion with many of our plans.”
Enwright declined to confirm coverage of Hundt’s aquatic PT; nor would he describe WPS’ position on covering aquatic PT in general.
In a statement, WPS Executive Vice President of Marketing and Business Development Scott Kowalski said “WPS does not comment on any specific customer situation.”
But he said the company has “a process for each and every WPS customer to appeal a health insurance claim that they believe was denied improperly. WPS customers can contact us with a request for appeal via mail, phone, or through email. We welcome WPS customers to utilize this avenue to address their concerns.”
Hundt was happy that it appears WPS will cover a treatment she feels helped her heal more quickly and was less costly than if she’d had to remain on dry land.