Independent Medical Review supports "aquatic therapy" as medically necessary - Part I

Independent medical review is the process where physicians review medical cases in order to provide claims determinations for health insurance payers, workers compensation insurance payers or disability insurance payers. These physicians are contracted to provide objective, unbiased determinations on what the root cause of the treatment was, whether or not there is medical necessity, if there was a sentinel event, what was the reason for it, etc.

Eavesdrop on some of the recent decisions which addressed whether aquatic therapy is medically necessary. Their findings might help you support your own treatment choices.

This is Part 1 of a multi-part series.

The Case: A 65-year-old female enrollee has requested water exercise with a physical therapist for treatment of her knee pain.

Findings: The physician reviewer found that the rehabilitative management of patients following total joint arthroplasty should be individualized and geared toward the specific functional needs of a given patient. A recent randomized controlled trial by Rahmann and colleagues has demonstrated the beneficial effects of aquatic physiotherapy following total joint arthroplasty.

In this patient's case, there is a significant pain component that could limit functional recovery. It is therefore likely that the patient will better tolerate and progress with an aquatics-based program as opposed to a land-based therapeutic exercise program. The requested services are medically appropriate and likely to result in an improved outcome for this patient as compared to land-based therapy.

Read full decision here...