How HEALTH INSURANCE PROVIDERS are limiting how we can support you.
Written passionately by Jodie Pulsifer and Adrienne Sim | Reviewed by the Whole FCP Crew
This week, for the first time, Pacific Blue Cross has issued an article to educate its policy holders about the physiotherapy coverage you are entitled to and what they are not considering as a part of your health care plan. This was news to all of us and we are saddened by the impact and harms it may cause.
In this article, Pacific Blue Cross has been very clear that Physiotherapy coverage is intended for the rehabilitation of an existing medical condition – like an illness or injury. The position that Pacific Blue Cross is taking is that Physiotherapy benefits are not intended to cover preventative, permanent or ongoing treatment.
We are incredibly saddened to read this article as FCP providers strongly believe in the ability of all people to seek healthcare that keeps them well and that follows best practice standards in care that foster habit change and economics of healthcare. While we support PBC in their quest to ensure there are no fraudulent insurance claims, we do not believe this position article will do that and instead hinders the essential care that policy holders thought they could receive.
FEMALE WORKERS IMPACTED MOST:
As Pacific Blue Cross is the single largest insurance provider in BC this impact is going to be significant. This shift will disproportionally impact public health professionals in the education and health sectors who have policies with Pacific Blue Cross and whose demographic is made up in majority by female workers. While Pacific Blue Cross has articles and initiatives clearly stating that 1 in 3 Women are not having their health needs met and have voiced initiatives to help address these needs, we believe this position statement is in strong opposition to what continues to be ongoing emerging evidence to best practice healthcare for women and trans people who are most at risk of gender based health inequities.
Women, birthers and people born with uteruses are not the people who are at greatest risk of acute injury and short term rehabilitation needs. They are the people who suffer most from gender based systemic health inequities and struggle most with non-acute, chronic and persistent health conditions and pain.
FULL CIRCLE PHYSIOTHERAPY CARE MODEL:
With this new information we want to let you know how we will continue to practice and what we will need to shift as we try to advocate for this to change.
BIRTHERS:
Out of the gates, Pelvic Health Physiotherapy services to support birthers through conception, pregnancy and post partum health challenges will continue to be one of the largest populations we support and will continue to do so. We have strong research for the work we do to help you get and stay active through direct 1:1 assessment and working on management of birth related pelvic health concerns. We will continue to support you with common pregnancy and postpartum related concerns including incontinence, pelvic girdle pain, birth injury and abdominal separation.
PEOPLE IN PAIN:
We will continue to work from a biopsychosocial and trauma informed lens that takes your whole health into consideration as we support you in learning about your pain, finding supportive strategies you can implement and giving you our 1:1 support as you need it to keep you able to engage in your life.
THERAPEUTIC GROUP EXERCISE:
We continue to have strong evidence that participating in group based care for pelvic health related concerns including incontinence and genitourinary symptoms of menopause is as effective as 1:1 care after you have had an individual appointment and your care is individualized to you.
Not only is therapeutic group exercise as effective but it is MORE FUN and more economical making it a meaningful way to get your rehab built into your life.
We have research to show that people in their 30s and 40s struggle most with self-directed exercise programs and may require more accountability to make progress. (To anybody in this stage, this feels like a no-brainer!). With a home exercise program alone, success for cure or significant improvement of urinary incontinence symptoms is 5-15% but in a supported environment success is upwards of 75%!
Because of the evidence in for group based care and the way we have always practiced, we will continue to run these programs for those who are working 1:1 with us and as part of your ongoing treatment plan. As always we will remain transparent about our care, we will provide you with individualized assessment and support that fits for you. During group-based session as concerns arise, we will document your individualized modifications and continue to maintain our college standards for this service.
Sadly, at this time to ensure no conflict with billings, we WILL NOT DIRECT BILL for these services. We will provide our regular physiotherapy receipts that you can maintain for tax purposes and consider inquiring about coverage directly with your provider.
If you have any difficulties accessing the care you need, please speak directly to your physiotherapist so we can best support you and ensure your health needs are not missed and neglected.
ADVOCATING FOR CHANGE:
Outside of our practices, we are actively working to support you and are engaged in communication with our college, association and members of parliament.
Wishing us all calm and steady days as we navigate these turbulent waters together.
Yours in health,
The Full Circle Physiotherapy Crew
Non-linked References:
1. Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2017 Dec 22;12(12):CD007471. doi: 10.1002/14651858.CD007471.pub3. Update in: Cochrane Database Syst Rev. 2020 May 6;5:CD007471. PMID: 29271473; PMCID: PMC6486304.
2. Motolla. 2019 Canadian guideline for physical activity throughout pregnancy Br J Sports Med 2018;52:1339–1346.
3. SOGC Guideline - No. 129-Exercise in Pregnancy and the Postpartum Period J Obstet Gynaecol Can 2018;40(2):e58–e65
4. NICE Guideline (NG210) Pelvic floor dysfunction: prevention and non-surgical management. Published Dec 2021. https://www.nice.org.uk/guidance/ng210
5. Cardoza, L, Rowner, E, Wagg, A, Wein, A, Abrams P. (Eds) Incontinence 7th Edition (2023). ICI-ICS. International Continence Society, Bristol UK, ISBN: 978-0-9569607-4-0.
6. Dumoulin, C, Cacciary, LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment or inactive control treatments for urinary incontinence in women. Cochrane Database of Systematic Reviews (2018), Issue 10. Art. No.: CD005654. DOI:10.1002/12651858.CD005654.pub4.
7. Rygh, P, Asklund, I, Samuelsson, E. Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study. BMJ Open. 2021. Jan 4;11(1):e040819. DOI: 10.1136/bmjopen-2020-040819.
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