US EditionTheir physical therapy coverage ran out before they could walk again
- A KFF Health News examination, dated March 28 2025, reveals that health insurers often limit physical therapy sessions to as few as 20 per year, impacting recovery for millions of Americans needing therapy after operations, diseases, and injuries.
- This widespread constraint in health insurance policies stems in part from an omission in the Affordable Care Act, with over 29,000 ACA health plans limiting annual physical therapy sessions, despite insurers claiming these limits help control costs and prevent unnecessary treatment.
- Katie Kriegshauser in Kansas City, Missouri, Amy Paulo in Massachusetts, and Mari Villar, a 15-year-old, each faced curtailed physical therapy due to insurance limits following severe health events in 2023 and 2024, hindering their ability to regain mobility and independence.
- As Marjorie Haney, a physical therapist who tore her rotator cuff in Maine, discovered, insurers like Anthem Blue Cross Blue Shield often require repeated assessments and prior authorizations, approving only a few visits at a time, though Maine passed a law in 2023 banning prior authorization for the first 12 rehab visits.
- With limited health insurance coverage, patients like Amy Paulo, who spent $1,445 out-of-pocket, and Katie Kriegshauser, who benefited from the Falling Forward Foundation, face the difficult choice of either halting therapy and potentially losing function or paying significant out-of-pocket costs, highlighting what Sam Porritt calls 'the gross reality in America right now'.
12 Articles
12 Articles
Broken rehab: Their physical therapy coverage ran out before they could walk again
Mari Villar was slammed by a car that jumped the curb, breaking her legs and collapsing a lung. Amy Paulo was in pain from a femur surgery that wasn’t healing properly. Katie Kriegshauser suffered organ failure during pregnancy, weakening her so much that she couldn’t lift her baby daughter. All went to physical therapy, but their health insurers stopped paying before any could walk without assistance. Paulo spent nearly $1,500 out of her own po…
kffhealthnews.org
Their Physical Therapy Coverage Ran Out Before They Could Walk Again
Mari Villar was slammed by a car that jumped the curb, breaking her legs and collapsing a lung. Amy Paulo was in pain from a femur surgery that wasn’t healing properly. Katie Kriegshauser suffered organ failure during pregnancy, weakening her so much that she couldn’t lift her baby daughter. All went to physical therapy, but their health insurers stopped paying before any could walk without assistance. Paulo spent nearly $1,500 out of her own po…
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