06/12/2026
Before reading this post, please know that I am the type of clinician who would love nothing more than to provide care at no cost to patients if I could afford to. Everything is so expensive.
For reference, I should tell you that I am an OT and specialize in Breast Cancer and secondary lymphedema rehabilitation. Two diagnoses protected by law in terms of clinical care for lymphedema and cancer
(The cancer act of 1998 revised in 2010 and the lymphedema treatment act in 2022)
Since that time, insurance companies have deemed my therapy globally not medically necessary one patient by another- this week United called and said that they are taking all 2025 reimbursement due to not medically necessary. If asked they why directly they will reroute us to Optum, an “independent “ reviewer - different company altogether. They own Optum. Maybe Optum owns them, maybe CVS owns them all. Isn’t that the definition of a monopoly? I learned in elementary schools that they were illegal. Perhaps I have to reread.
The main insurance companies will not pay without justification of medical necessity. I submit documentation. They perform a review. They deem care medically necessary and pay for dates of service. Last week I received a call from one company stating that the visits were not medically necessary and either I demonstrate necessity again, if they maintain that the visits are not medically necessary they will hold money back from future care reimbursements.
I provide a specialized 60 min individual session for every single patient. My therapy focus remains on patient care created individually to make management of their diagnosis not lifestyle impacting as much as possible.
I love what I do, I care about and for each and every patient like they are family. I am available 24-7 for them. I am not a concierge clinician. I care. Unfortunately, though I have kept my head in the sand for years, I am admitting defeat with these insurance companies.
Is the suggestion that we stop accepting insurance even out of network, have patients pay upfront while in a whirlwind of medical issues they had hoped to never have. Is that what we want from healthcare? Where’s the care?
Can someone please explain - with all of the appeals, letters of medical necessity, peer reviews, etc how do we maintain our focus on patient care? I want to be the best clinician, advocate, and support system for my patients. The patients thrust into the maze of medicine because they were unlucky (to say the least). I’m defeated. Logic is gone Caring about and for the patient is optional ☹️
I will never stop being the clinician that I am. I will always be a patient advocate and support OT, whatever they need me to be. Something has to be done to change what has happened to healthcare. It’s exhausting.
