by John J. Schessler, Jr. CMT, ET-C, TCS

Have you ever had a surgery or procedure and one of the first things your doctor discusses with you is physical therapy to assist with your recovery. Okay, great, you have insurance, so it’s covered right? Well yes and no. The healthcare disaster in the US when it comes to co-pays is utterly ridiculous and a lot of people these days are foregoing physical therapy and taking recovery into their own hands because either the co-pays are too expensive, or the patient feels that the physical therapy isn’t really accomplishing that much for their recovery. The mere fact that people have to make such a choice is proof enough that we have an issue that needs looked at in our healthcare systems when it comes to insurance companies, what they cover and how much is left up to the consumer. Let’s dive in.

As far as insurance companies go, there’s about seven different categories that medical professionals can bill under – co-pays for the primary care doctor, emergency room, etc. Physical therapists fall under the specialist category, billing for services rendered for broken bones, post-op surgery rehab, etc. A lot of times insurance will only pay for so many sessions and once they run out, so do the patients from continuing unfortunately, that is, if it’s an outpatient setting. What stops the patient from continuing therapy more time than not is, you guessed it, the co-pays. What happens next then?

Enter the Personal Trainers.

Picture this: You’re a few weeks out from having a total shoulder replacement. You’ve done inpatient physical therapy as well as a few sessions of outpatient physical therapy and you’re starting to gain range of motion back and things seem to be improving. One day, your PT begins the therapy session with a review of your insurance coverage and unfortunately, this week will be your last due to what the insurance has agreed to cover. Later at home, you think about joining your local gym and the next day you sign up and meet with the Trainer on staff, me.

I’m not new to hearing this during my client consultations. The famous line I hear is usually, “I was going to physical therapy, but my insurance ran out so here I am.” All personal trainers hear this from time to time and if they’re good Trainers, they’ll know exactly how to handle it. At my gym, all members receive the awesome benefit of training services I provide to the gym community, so I’m extremely used to treating physical therapy-type issues people come in with and want help managing it. If the issue the person is having is out of my wheelhouse, I let them know it up front so there is no confusion that what I provide isn’t 100% therapeutic but more strengthening and improving your body’s limits. 

A lot of people subscribe to the myth that personal training and physical therapy are the same thing. They are not and they shouldn’t be. One is performed for medical reasons and the other is for fitness, health and self-improvement. I’m not going to turn away a member because I’m not a DPT, I do have a working knowledge of PT modalities so I can rely on what I learned in college and thereafter to assist me. Obviously, any other trainer can to and as long as you don’t create bigger problems or injure the client, there are ways to train the affected issue and rehabilitate the person back to a functioning level. In all seriousness, DPT’s and CPT’s are very similar in things they can train and rehabilitate on a person. The major differences between the two are that DPT’s need to have a solid medical background of advanced medical terminology/skills to treat affected areas. CPT’s have working knowledge of kinesiology, anatomy/physiology, etc. but what we can’t do is diagnose, treat bone breaks, immediate post-operate surgical injuries, etc. 

There’s always a loophole when it comes to co-pays and what I mean here is that you can make the decision to take matters into your own hands, go to the gym and seek the assistance of a trainer to assist you in your rehabilitation. Whatever the decision that you make, please make certain that you have checked all available forms of insurance and what’s covered before seeking a personal trainers help. There are legal headaches that could be involved if a CPT injures the client without the proper informed consent paperwork or knowledge of what is to be completed in the gym sessions. 

Other trainers may read this and think it could never happen to them and odds are it won’t BUT….knowledge is power and sometimes we tend to let this stuff slip our minds, so it’s always good to be reminded of the ‘what-if’s’. At the end of the day, the power lies in the hands of the injured party. Do not allow your Physical Therapist to talk you into more sessions that you’ll be paying out of pocket if that’s not what you want or can’t afford. On the flip side, don’t go seeking a personal trainer out if you are having doubts about what kind of assistance you will be receiving without doing your homework first.

We need to start empowering ourselves to speak up with our medical doctors, practitioners and trainers if there is something we feel isn’t right or in our best interests. They’ll respect you so much more for being upfront with them because hiding behind lies helps no one and you’ll end up losing in the end.

John Schessler is a Pittsburgh-based certified Master Trainer, Motivational Speaker, Actor, Writer and host of the podcast, “Flip Your Script”, available on most podcast platforms. He has been working in the health & fitness field for 17 years and has certifications as an Orthopedic/Sports Injury Specialist, Tactical Conditioning Specialist and Exercise Therapist. Aside from his work in fitness, John has backgrounds in Special Education, Social Work, Psychology and Child/Adolescent Development. For speaking engagement questions or training inquiries, please email John at pghwellnesspt@gmail.com

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