Medicare coverage for pelvic floor after vaginal surgery?

Posted by lindes @lindes, Mar 8 1:27pm

Does anybody know id medicare pays for pelvic floor physical therapy? I recently had vaginal surgery and would need to strengthen my pelvic floor muscles again

@lindes Welcome to Mayo Clinic Connect, a place to give and get support.

I hope that your surgery went well. It's important to get the necessary treatment to live your best life.

There are a couple of questions that need to be answered before you can get an accurate idea if this treatment will be covered.

Are you experiencing urinary incontinence and do you have straight Medicare, a supplement, or HMO advantage plan?

Once you answer these questions I'll try to connect you with members that may be able to offer support.

I'm wondering if you have considered contacting the prescribing doctor to have the hospital verify the insurance?

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@erikas

@lindes Welcome to Mayo Clinic Connect, a place to give and get support.

I hope that your surgery went well. It's important to get the necessary treatment to live your best life.

There are a couple of questions that need to be answered before you can get an accurate idea if this treatment will be covered.

Are you experiencing urinary incontinence and do you have straight Medicare, a supplement, or HMO advantage plan?

Once you answer these questions I'll try to connect you with members that may be able to offer support.

I'm wondering if you have considered contacting the prescribing doctor to have the hospital verify the insurance?

Jump to this post

The hospital is the Mayo Clinic in Rochester, Minnesota, Methodist Campus. The surgeon suggested pelvic floor therapy might be a good idea, but that was it. I live in southern Florida, and got no other advise from the surgeon
I have Medicare and a Plan F on top of it I had a vaginal canal reconstruction, the surgery did not cost me anything, but I have no clue about the therapy.

REPLY
@lindes

The hospital is the Mayo Clinic in Rochester, Minnesota, Methodist Campus. The surgeon suggested pelvic floor therapy might be a good idea, but that was it. I live in southern Florida, and got no other advise from the surgeon
I have Medicare and a Plan F on top of it I had a vaginal canal reconstruction, the surgery did not cost me anything, but I have no clue about the therapy.

Jump to this post

@lindes Insurance can be confusing in the best of times. I worked in insurance and it still trips me up sometimes.

You may wish to find a local location where you can do the therapy. That facility should be able to let you know what kind of insurance coverage you should expect.

You'll notice that I changed the title of your question. I did this so you can connect with members more easily.

While I'm working to find members that may be able to answer your question, I'd like to invite active members and mentors @marjou @court135 @blinken @hopeful33250 @gingerw to join the conversation. While they may not have the immediate answer for you I'm hoping someone may be able to point us in the right direction, correct conversation, or like member.

May I ask if you have considered calling Medicare to ask this question?

REPLY

I suggest you call the number on back of Medicare card and ask them. With so many different type Medicare programs, it is hard to advise.
Another option is to contact the location where you would receive the therapy and ask them .
You might need a letter from surgeon saying it is medically necessary.

Laurie

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@erikas

@lindes Insurance can be confusing in the best of times. I worked in insurance and it still trips me up sometimes.

You may wish to find a local location where you can do the therapy. That facility should be able to let you know what kind of insurance coverage you should expect.

You'll notice that I changed the title of your question. I did this so you can connect with members more easily.

While I'm working to find members that may be able to answer your question, I'd like to invite active members and mentors @marjou @court135 @blinken @hopeful33250 @gingerw to join the conversation. While they may not have the immediate answer for you I'm hoping someone may be able to point us in the right direction, correct conversation, or like member.

May I ask if you have considered calling Medicare to ask this question?

Jump to this post

I have not, because each time I called them, I knew more than they did (I am a retired medical doctor myself), and it was wasted time. I just had never dealt with a condition I have, and was hoping to get more information here.

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@roch

I suggest you call the number on back of Medicare card and ask them. With so many different type Medicare programs, it is hard to advise.
Another option is to contact the location where you would receive the therapy and ask them .
You might need a letter from surgeon saying it is medically necessary.

Laurie

Jump to this post

I will contact the surgeons assistant through the porthole and ask for such a referral

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Believe it or not, there are physical therapists , at Mayo, that help with exercises that build up your pelvic muscles, they work through your vagina or anal area, with exercises to strengthen that area. Very helpful if you have had a hysterectomy or any other kind of surgery.
It is amazing. I go to Mayo in Jacksonville.

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Is there a Mayo in the Raleigh NC area?

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@miriam57

Believe it or not, there are physical therapists , at Mayo, that help with exercises that build up your pelvic muscles, they work through your vagina or anal area, with exercises to strengthen that area. Very helpful if you have had a hysterectomy or any other kind of surgery.
It is amazing. I go to Mayo in Jacksonville.

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Thank you, but i live in Fort Myers, a long stretch away from Jacksonville, and i would like to get this therapy done locally if possible

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A urogynecologist prescribed physical therapy for me, which I had in 2018. It was covered by both Medicare and our Medigap policy, which is the federal Blue Cross/Blue Shield plan known as CareFirst. I am probably going to need surgery because the pessary I was using was causing an ulcer with bleeding. I had to take a vacation from the pessary to allow the ulcer to heal. After the second vacation, the pessary would come out when I went for a walk, even when the doctor had inserted it.He tried the next size, but determined that it was too large. When it worked, the pessary held things up well. Without it, the vaginal wall bulges out, which is very uncomfortable and sometimes causes some incontinence. I was in touch with the physical therapist again recently to ask whether the exercises are still helpful at this point. She said that even if I have surgery, strengthening those muscles will help in recovery. I hope this is somewhat helpful.

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@lindes

The hospital is the Mayo Clinic in Rochester, Minnesota, Methodist Campus. The surgeon suggested pelvic floor therapy might be a good idea, but that was it. I live in southern Florida, and got no other advise from the surgeon
I have Medicare and a Plan F on top of it I had a vaginal canal reconstruction, the surgery did not cost me anything, but I have no clue about the therapy.

Jump to this post

@lindes I had pelvic floor PT a couple of years ago and there was no problem with my Medicare paying for it. I have regular Medicare and also Plan F for my supplemental. I never thought to check but you may want to just to be sure. I just figured it was PT and they pay for a certain amount of PT.

My doctor (urogynecologist) provided me with a list of all of the Pelvic Floor therapists within quite a few miles. Since your doctor is in MN and you are looking for PT in FL that doctor may not have that resource but I'm sure you can find out somehow.
JK

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@lindes

I have not, because each time I called them, I knew more than they did (I am a retired medical doctor myself), and it was wasted time. I just had never dealt with a condition I have, and was hoping to get more information here.

Jump to this post

@lindes I should have asked and not assumed as much. From what I saw it looked like it was covered for certain diagnoses. You would think that surgery would show medical necessity but, as you know, it doesn't always work that way.

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