Frequency of Physical Therapy - Debate with insurance company

My son is now 12 years old and ambulatory. He has been receiving PT from a professional 5 days per week for the past 5 years. The insurance company has now decided that 1 to 2 days per week is sufficient and there is no "medical necessity" for 5 days per week. I have an opportunity to appeal that decision and am trying to put together a comprehensive set of information from publications and anecdotal data that shows that 5 days per week is beneficial to the health of the 12-year old DMD patient as compared to a 1-2 days per week regimen. From practical observation my wife and I already know this as the days our son doesn't receive physical therapy his mobility is reduced and his mood can be off however the insurance company is not swayed by our personal observations. 

Can anyone share references to published knowledge as to whether more request physical therapy (stretching mainly) is better than less-frequent? Additionally, if there are any PT professionals in the audience and willing to share your professional opinion that would be very helpful. 

Thank you and feel free to reach out to me if you have questions, comments or suggestions.

Manu Gambhir

manu@gambhir.net

917-573-0390

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Good luck... It is a battle I too fought years ago but lost. My son still received frequent pt but through the school district APE program not actual PT

this is a battle most of us parents fight. my son is 8 and he does pt in school once a week and outside of school once a week. the actual pt doesnt think that it is beneficial for my son to do more than 45 minutes a week in pt. he is now in a wheel chair but he is still ambulatory. so if just depends on how progressed ur sons dmd is for what they can do and how much they feel will help.

Thank you for the useful responses. Much appreciated.

While daily physical therapy, especially stretching, is good, most, if not all insurance companies, will not pay for daily physical therapy indefinitely (for Duchenne or any other ailment).  In the end, the only way to get sufficient PT is to do it at home on a regular basis. In fact, very few insurance companies would even pay for 1 or 2 a week indefinitely.  Your company actually has been quite generous.  The more realistic program is to get as many professional sessions as you can get, and do the rest at home (in accordance with the program you develop with your physical therapist). Just my experience.  Without developing a home stretching program, there is no way to get in the necessary stretches (unless you have enough money to pay for a PT on your own). For many years, we have just occasionally gone for an evaluation of range, etc., and viewed PT as a home program.  My son is 19 and still ambulatory.  He wears a night splint on one leg (we can't get him to wear both-his range is only off on one leg).  And he can still do some stretches on his own.  When he was younger, my wife did his stretches in the evening.

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