CONSUMERS : State Provides Help in Physical Therapy
Question: As a physical therapist, I was interested in your recent column about the lady who wrote regarding the need for physical therapy for her infant son. If you can contact her, she should know that her child would be eligible for free physical therapy services, either in-home or center-based, through state regional centers. She probably is in the boundaries of the one on the west side of town if she has been using Cedars-Sinai Medical Center. If not, they could refer her to the correct one.
Also, when her child turns 3 years, services could be provided through California Children Services (CCS), which is located in many therapy units within the Los Angeles city and county schools.
It’s a real shame what Blue Cross and other insurance companies are doing. There’s no way 12 sessions a year at $25 per session could begin to fill that child’s needs. Even Medi-Cal rates are $31.91 per visit for in-home physical therapy, and that’s the lowest rate around. (That’s what regional centers pay us therapists who contract with them).
I recently had my own battle with an insurer to get paid for therapy services I provided to a patient. It took lots of documentation on my part to justify the need for my services, many aggravating phone calls and then continued review by everyone imaginable to finally get paid--six months later, I might add. It hardly seems worth the effort to provide services to insurance patients anymore when you have to fight to get paid. I hope you can get this information to the lady with the developmentally delayed son.--G.S.
Answer: Yes, I’m indebted to you for passing the information along. Both of the sources you suggest are potential suppliers of physical therapy for Mrs. Z. A.’s son, who was born prematurely two years ago and needs therapy in learning to walk. (Blue Cross had provided 80% of the two- or three-times-a-week treatment at $125 per visit but, last year, cut physical therapy reimbursements on all of its Prudent Buyer policies to a maximum of 12 sessions per year with a $25 cap on each such treatment.)
Of the two options you mention, California Children Services and the state regional centers, CCS may be the better bet because the eligibility standards are somewhat broader than they are at the regional centers.
According to Frank Rico, director of the L.A. County Department of Health Service’s Children Services program, the agency maintains 43 medical therapy units--many of them small, consisting of two or three therapists engaged in both physical and occupational therapy. Because this is considered part of the child’s education, Rico adds, the service is provided without charge through the primarily state-funded agency.
More specifics
“However, we have to know more specifics about the child’s needs to determine his eligibility, and, of course, it has to be prescribed by a physician who has been paneled by the state,” Rico says. Some treatments “like medical intervention, do contain some financial-eligibility yardsticks before the mother can qualify, financially.
“And so, a medical determination first has to be made and then, based on the child’s needs, we can either provide the service ourselves or farm it out.”
He isn’t clear, however, what you mean when you say “when he (the child) turns 3 years of age” because CCS has no minimum-age eligibility.
Rico suggests that parents call his office in Marengo for directions to the medical therapy unit nearest their home: (213) 226-2469.
And, as you suggest, another source of possible help is through the state regional centers, private, nonprofit organizations that contract with the state. There are 21 regional centers state-wide, seven of them in the Los Angeles area.
But here, according to Mary Rollins, director of client services for the state regional centers, the agency offers no direct services. Instead, the centers provide diagnostic assessment, case coordination and individual planning, Rollins adds. “And then, if the patient is eligible, we broker them out to facilities that are available in the community.”
And physical therapy, as such, isn’t the key goal with the regional centers. “We work with people having mental retardation, epilepsy, cerebral palsy and autism, and physical therapy is just one of the services.
“The child you mention,” Rollins said, “might potentially qualify for physical therapy if our diagnostic assessment establishes that either mental retardation, epilepsy, cerebral palsy or autism has created a substantial physical handicap requiring therapy.”
The primary eligibility is that the child isn’t already receiving treatment either through the schools or through CCS, and the only age stipulation is that the condition mandating the therapy must have occurred before the age of 18.
Rollins suggests that you contact the regional center at Culver City, and ask for the intake department: (213) 337-1155.
Again, Mrs. Z.A. and I thank you for the tip.
Question: I retired from full-time employment on my 64th birthday and started to collect Social Security. After one year of complete retirement, I decided to take a part-time job, working only two days a week for a total of 16 hours per week.
In view of this employment, my employer deducts all the necessary deductions from my earnings (FICA, state and federal withholding and state disability). In view of the fact that my Social Security checks were originally calculated on my highest earnings, I would have no way of increasing my Social Security monthly payments, based on the additional income I am presently earning. In no way would a part-time job add anything to my “highest” period of earnings because I did formerly work full time.
Therefore, you can see that any monies that are presently deducted from my earnings are not helping me to increase my future Social Security earning and are merely going into the Social Security fund for future beneficiaries. Please advise if this assumption is correct and/or if there is anyway that I can avoid these deductions.--S.R.
Answer: Your assumptions, alas, are correct and there’s nothing you/I/they (Social Security) can do about it. Once you re-enter the work force, part time or full time, the old withholding gambit that you retired to get away from is securely back in place. And yes, those Social Security withholdings from your check are, sure enough, going right back into the same giant pot from which your own monthly benefits are coming. A very peculiar game of round-robin.
Little Comfort
I know you can’t take a lot of comfort in it, but because--in retirement--your income tax liability has probably dropped off sharply, you’ll very likely have most, if not all, of that tax withholding returned to you.
And, of course, there’s no way in the world that the part-time earnings can ever lower your monthly Social Security check. It’s firmly in place and will increase as cost-of-living adjustments are made to it.
No, I was afraid that this wasn’t the answer you were hoping for.
Campbell cannot answer mail personally but will respond in this column to consumer questions of general interest. Write to Consumer VIEWS, You section, The Times, Times Mirror Square, Los Angeles 90053.
