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

@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?

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@erikas Thank you for tagging me. While I have not worked in the insurance business, my health issues have forced me to get very involved with providers and insurance! @lindes It is important that your medical team use the correct procedure number. My simple suggestion is to call medicare and ask your question. You may not get any proper information, based on who answers, but many of the people are very good. You can go to the medicare website and check, also. https://www.medicare.gov/what-medicare-covers
Ginger

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@luftmensh1

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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Thank you, that helps a lot!

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@contentandwell

@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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Thanks, i will do my own search here, but now that i know that they will pay, I can be a little more involved in my search.

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@erikas

@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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Well the good doc from the mayo said physical therapy would be a good thing to do. I should have followed up with him for a prescription, but it was the day of being released from the hospital, and I had my head spinning anyway. But I will check back with them.

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@gingerw

@erikas Thank you for tagging me. While I have not worked in the insurance business, my health issues have forced me to get very involved with providers and insurance! @lindes It is important that your medical team use the correct procedure number. My simple suggestion is to call medicare and ask your question. You may not get any proper information, based on who answers, but many of the people are very good. You can go to the medicare website and check, also. https://www.medicare.gov/what-medicare-covers
Ginger

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Thanks, i will work me through this site!

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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.

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@lindes I have pelvic dysfunction w/some incontinence, had vaginal tightening surgery years ago. Mayo doc in Jax is working w/me now re these issues, several are active now, She referred me to a physical therapy in Jax that specializes in this type of therapy and I'm scheduling tomorrow. Not pleased with this diagnosis, but expect this will help and Medicare and my United Health Care Plan F cover the cost 100%. Blessings and I hope you get the help you need. elizabeth

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@cichocki06

Is there a Mayo in the Raleigh NC area?

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I did a search, Duke University OB-Gyn offers pelvic floor therapy in Raleigh NC. I used to visit there when I worked with John Deere.

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@lindes

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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I just did a search. Pelvic Floor Therapists, there were a few listed. I hope this helps

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Thank you all, I found a few therapists around my area, and i have to get an order from my Mayo doc now, and will contact them to see if they take Medicare.

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@miriam57

I did a search, Duke University OB-Gyn offers pelvic floor therapy in Raleigh NC. I used to visit there when I worked with John Deere.

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😁🤗Great…if you can get to the help you need at Duke, sounds like a good idea. And I bet there's no reason why your Medicare should be a problem. Just a call and you're on your way!
Blessings on your way to being a better you!
Elizabeth

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The physical therapy I had for prolapse did include biofeedback and was covered, as I noted before.

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Hello @lindes,

I have similar coverage as you. Medicare, plus Part F (Medigap), and my pelvic floor therapy was completely covered. As it has been suggested, the facility where you make your appointment should have a good idea as to what your insurance will cover. If the facility puts the responsibility on you for finding out about coverage, then call Medicare (I've found an early morning call to be the best time to get through) and ask about the coverage.

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