Insurance Ran Out, But I'm Not Ready to Play
Updated: 5 days ago
Let's set the scene - you have been grinding at physical therapy for months. You have improved your strength, range of motion, tolerance for activities of daily living, and the pain is MOSTLY gone. The insurance company calls; you are maxed out due to your insurance cap, or the next round of visits was denied. Here is your home exercise program and your discharge gift.
The only problem is you aren't ready to sprint, jump, throw, or get back onto the field, and you know it.
This is a common occurrence we see at ARC Sports Performance, and it is not anyone's fault. Insurance-based clinics do great work within the limitations that they are given. However, those limits are usually built around getting a patient back to daily life, not back to their sport or recreational activity. For an athlete, that is halfway.
Why does this happen?
Most insurance plans cover a patient until the patient is "functional" or physical therapy is no longer medically necessary in the eyes of the insurance agent. This is a reasonable goal for most people; however, athletes have a different demand. The work that bridges "functional" to back to sport is strength, power, conditioning, and sport-specific training.
This gets cut short when visits run out. When this happens, three things can occur:
Some try to finish the rest of the rehab on their own and guess when they are ready
Some train with a strength coach or personal trainer who may not know the full picture
Some just return to play and find out the hard way what they were not ready for
Why does this matter?
When we are finally making excellent progress with physical therapy and are forced to stop is like getting pulled from the fourth quarter while you're up by two.
The end of rehab is not the time to cut corners. Researchers who followed athletes back to cutting and pivoting sports after an ACL reconstruction found that timing and strength both mattered. Waiting longer to return lowered the chance of a second knee injury with every month up until about nine months after surgery, and athletes whose injured leg was closer in strength to their healthy leg got hurt less often. Athletes who did not pass return-to-sport testing before going back also had far more reinjuries than those who did, roughly 4 in 10 compared to about 1 in 20 (Grindem et al., 2016).
The strengthening that has to occur after you get denied or cut off is the part of rehab that actually prepares you for your sport and reduces the risk of reinjury significantly. Being pain-free and climbing the stairs with reduced pain is not the same as being ready to play, and the work that closes that gap does not stop just because your visits did.
Picking up where your rehab left off
Transitional care is more than a training program. If you still need hands-on treatment, help managing pain or swelling, or support addressing a lingering impairment, your physical therapy continues during those same sessions. With a physical therapist leading every session, your plan can adapt day by day, shifting between rehabilitation and performance training based on what you need.
Because ARC is out of network, your care isn’t limited by an insurer-approved number of visits. Your plan is guided by what it takes to get you back to your sport, not by a visit limit.
The process starts with an evaluation to see where you are right now. That includes strength testing, movement assessment, and, when it is appropriate, return-to-sport testing such as hop tests, so we have a clear picture of what is left to work on. With your permission, we also communicate with your surgeon, athletic trainer, and previous physical therapist if needed, so nothing about your injury or progress gets lost.
From there, every session is one-on-one with Dr. Justin Marceau, PT, DPT, OCS, ATC, CSCS. The program is built on strength and conditioning principles, so the focus is on building real strength, power, and conditioning, and gradually working into running, jumping, landing, cutting, throwing, or whatever your sport demands. Progression is still based on healing timelines and on meeting specific strength and movement standards, so you are not being rushed, but you are also not being held back when you are ready. Treatment may also consist of various manual techniques, dry needling, cupping, and other myofascial techniques to improve tissue quality, promote proper movement patterns, and decrease tissue irritability
The goal is not to keep you in physical therapy forever. It is to get you back to your sport with the strength and confidence to stay there, and to teach you how to keep training on your own after you are done. For athletes who want it, we can also continue working together on their strength and conditioning once they are back to full competition.
Is ARC Sports Performance the right fit for you?
Rehabilitation and transitional care at ARC Sports Performance may be a good fit if:
Your insurance visits ran out or were denied before you felt ready to return to your sport
You were discharged from physical therapy but still do not trust your injured area
You have not passed return-to-sport testing, or worse, you were never tested
You are being cleared by the calendar, not by quality and objective data
You want someone who understands both the rehab and the performance side of your recovery
Let's finish what you started
Running out of visits does not mean you are done. If you are stuck between "discharged" and "ready to play," ARC can help you close that gap. Patients pay at the time of their visit, and we provide a superbill that can be submitted to your insurance company for potential out-of-network reimbursement.
To talk through your situation, book a phone consultation at arcsportsperformancect.janeapp.com, call (203) 200-0423, or visit arcsportsperformancect.com.
ARC Sports Performance: the bridge between rehab and results.
References
Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804-808. doi:10.1136/bjsports-2016-096031
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