Biofeedback Incontinence Therapy - Who Pays?
|There have been many studies — virtually all with good results — that have shown the effectiveness of biofeedback in treating female urinary incontinence. Unfortunately, most of the evidence in the past had been either anecdotal or lacking enough controls to be convincing from a medical science point of view. Consequently, many public-funded health care providers in Canada had been hesitant to adopt biofeedback as an accepted method of treatment. |
This situation is rapidly changing. Enough convincing scientific data are now available so that more of the publicly funded provincial health programs in Canada can, and should, advocate biofeedback as the primary treatment method. Biofeedback by itself, however, is not enough. The technique of choice is Multiple Behavioral Therapies (BT) — which includes a roster of compatible treatments: EMG biofeedback, muscle stimulation, weighted cones, perineometry, home training and diet. This is the method that many progressive clinics are already practicing, with consistently good results and high patient satisfaction.
When you are looking at treatment alternatives and costs, it is the price of clinical treatment time plus the price of products that must be considered together. Products can include probes, sensors, surface electrodes, pelvic floor exercisers, cones and home treatment rental units.
As BT becomes more widely accessible, it will be more common to catch the early onset of incontinence, when treatment is quick and easy using BT. This will even further reduce health care costs.
Similar biofeedback techniques are successfully used for treating faecal incontinence, pelvic pain and male urinary incontinence.
Now that more options are available, who provides the treatment, and pays for the treatment costs? Several delivery models are emerging:
1. Private Physiotherapy Clinic
This typically includes physiotherapy and will usually pay for the full cost of treatments and products. If you are receiving disability benefits, then there is especially high motivation for the payer to promptly correct the incontinence problem. In some provinces, Medicare pays part of the fees, with private insurance or the patient paying the balance.
To be able to effectively bill your insurance company, the physiotherapist will likely need to establish that the treatment is appropriate, needed and medically necessary, i.e., ordered by a physician.
2. Hospital Physiotherapy Clinic
To help to deal with an increasing waiting list, many hospitals make good use of home trainer units. This reduces the duration and number of in-clinic sessions and generally can be highly satisfactory for both you and the hospital. Clinical sessions, and sometimes the probes and limited use of home trainers, are covered by Medicare. Your private insurance should pay for any other needed products.
3. Home Care
Because of these restrictions, some urologists offer a full program of clinical treatment on a premium service, patient-pay basis. This can be the most flexible for the patient. It is an ideal option for the patient who is willing and able to pay the fees. In some offices a nurse continence therapist conducts the therapy.
Each of these types of health providers can be highly effective; each has the ability of giving high quality therapy with durable results.
Because we have universal and comprehensive public health coverage in Canada, patients usually expect that there will be no fees charged for medically necessary treatment. Whether the patient, the employer or the government pays the health care premiums, we should be able to access these insured services when medical needs arise.
Unfortunately, this is often not the case. If you are seeking treatment from a provider that is not covered by Medicare, and if you do not have extended medical insurance, you should consider the costs in the same light as other needed but non-covered services such as dentistry or psychotherapy. These costs for our well-being are small compared with the ever-increasing cost of absorbables and lifestyle restrictions.
When planning treatment for incontinence, you should strive, where possible, to find a provider who can access Medicare and/or private insurance to the maximum extent covered by the plans. A provider that can offer a full roster of the effective treatment methods has the best chance of success and, with a persistent approach, should be able to receive prompt approval from private insurers when necessary. One that offers only behavioral counseling, or only muscle stimulation, for example, might not meet the criteria.
Your BT clinic will not necessarily use every method for every patient, but should have a range of methods available, as necessary, to ensure the best possible results for all of their patients.
Your comments and suggestions are welcome. For more information on continence therapy products, contact your health care provider, or BIOMATION 1-888-667-2324