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.
Another option is surgery, but only rarely is surgery needed to correct female urinary incontinence.  As BT becomes more widely available, the surgical approach, along with extensive urodynamic testing, will quickly go out of favour because of its high cost to the health care system, elusive long-term outcomes and risk of complications.

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
Numerous private clinics offer BT as a specialty service.  Such clinics are well equipped to deliver focused, and results-oriented therapy programs to patients for accident and disability insurance companies.  Many patients have private insurance with extended health benefits from their employer.

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
An increasing number of progressive hospitals provide BT as an outpatient service.  Unfortunately, some — but not all — physiotherapy clinics are seriously under funded and, if so, prospective patients must face a long waiting list or seek treatment elsewhere.

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
A few home care agencies provide BT.  A nurse continence advisor or physiotherapist can give continence therapy sessions at the patient's home using portable instruments.  The community health care program usually covers the cost of the treatment.  Your private insurance pays for the products.

4. Urologists
A few urologists and urogynecologists are providing BT.  Although Medicare covers the consultation and testing by a urologist, it will not usually pay for the full cost of a series of treatment sessions.  There are differences from province to province and from region to region.  Some Medicare programs will cover limited amounts for assessments, consultation and a small number of treatment sessions.  With the doctor's guidance, you can often do most of the treatment at home using a home trainer paid by your private insurance.

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.

Reilley, S.F.  Urinary Incontinence: treatment using behavioral therapy protocol.  The American College of Obstetricians and Gynecologists, 48th Annual Clinical Meeting, May 2000.

Your comments and suggestions are welcome.  For more information on continence therapy products, contact your health care provider, or BIOMATION  1-888-667-2324

BIOMATION encourages the adoption of new medical techniques and technologies, especially where there is active patient participation. 
The company is not funded by any special interest groups.  It derives all of its revenue from the sale of its products and from fees for its professional courses in clinical practice.