Over the past 1.5 years, since implementation of Anthem’s utilization management program for physical therapy, administered by AIM Specialty Health, physical therapy providers in Indiana and the other states AIM is present, have been challenged by obstacles.
These challenges range from inappropriate visits authorized (often 4-6 initially and 2-4 with 2nd/3rd requests) and denied care that is reasonable and medically necessary, to long wait times scheduling (45 – 60+ minutes), what often become, unproductive peer to peer reviews in an attempt to extend physical therapy services.
Patients, as a result, are not consistently receiving the care they need due to limited/denied visits, denial of requested treatment codes, or delayed care due extensive periods of time passing while authorization is pursued. Providers are also losing patient care time due to this administrative burden. Furthermore, Anthem/AIM recently added several common modality CPT codes to their list of exclusions further restricting reasonable and necessary services.