Episode 3 | Why Insurance and Healthcare Fall Short for ACL Rehab

Welcome back everyone to the ACL Athlete Podcast episode number three. And today we’re talking about insurance and healthcare and how that falls short for ACL rehab. It’s short and sweet. So let’s just get straight into it. So I’m gonna start, try not to go on a rant here, but I just wanna talk about my experience with insurance and healthcare.

As a patient, I talked about in the last episode, how I accrued a ton of debt from my second ACL surgery. And that was because of the bad insurance that I had. I had a huge high deductible and out of pocket max. I’ve seen this as a professional, working with different people whether it’s ACL injuries or other different injuries that they’re dealing with.

It’s a big reason why I decided not to take insurance with my practice. And the other side to this is seeing my dad go through this. He had a big scare where he had some blockage in some of his arteries in his heart, and he had to have an emergency stent procedure. And this is a small business owner who has pretty terrible insurance.

He doesn’t know much about healthcare or the medical model or insurance. And me and my brother would step in and help out with this. And what ended up happening, is he accrued a ton of debt from this, just because of the insurance that he had to purchase as a small business owner. The premiums he had to pay month to month were just insane so you take the risk of buying something of a lower price to be able and hope nothing happens. Anyways with that said, I just think that it is very much driven by money rather than the human in front of you, the care that we’re trying to provide some for someone. It’s very reactive. We wait till something happens till someone gets sick and fix it rather than proactive whereas pushing forward health and movement and good nutrition. And don’t get me wrong, there are people out there who are doing incredible things with this and trying to push this forward this type of proactive care. But right now our model in the U.S. is just really designed to just be reactive to these types of situations.

And today, I want to talk about why this model is not set up for ACL rehab. So let me paint a picture here of what this looks like and what this could potentially look like to help someone who’s going through this issue. So the normal process is you injure your ACL and you go see an orthopedist. They send you, typically, to go get an MRI and then they decide, do you have surgery or do you not. More oftentimes than not, if your ACL is torn, the norm is to go and have surgery. Now the caveat is there’s more and more research showing that there’s a lot of people who can cope without having their ACL. But it depends on the context that’s for another episode, but let’s say you go and have the surgery. You meet your max deductible and out of pocket max you end up paying a good chunk, whatever that is with your premium and all those things.

And then you get granted physical therapy visits. So on average, you’ll see somewhere around 30 to 40 visits and if we’re using the nine month mark as your clearance for return to sport, you’re good to go because we know at this point, no one should be returning to sport before nine months unless you have some sort of very unique context. No one should return to sport by nine months. And I’m gonna stand firm on that. 

So your post-op and it’s normal to see three times per week of physical therapy visits, but. If we do the math, that’s 10 weeks. That’s two and a half months. If we say there’s 40 visits, then that’s 13 weeks. And that’s just a little over three months. If we say it’s two times a week, post-op, then that may stretch you to 15 to 20 weeks. So that’s almost four to five months. And then if you do one time per week, then that’s 30 weeks, 40 weeks which ends up coming out a lot longer, but it’s a bit unrealistic. The reason I say that is because of the way traditional physical therapy is set up in a session, it would be very difficult to accomplish what you need to learn and do, and all those tasks based on one session per week in the traditional clinic, just because there are typically multiple people that are being treated. And for ACL rehab, there needs to be more attention at certain phases in the process. So then what? You’re out of physical therapy visits. What do you do? Time is usually the main thing that is determined for clearance and return to sport.

And if you’re using the 30 visits and it’s three times per week even, if you stretch that out at two times a week, that’s still not enough time to get to the place of that nine month mark of where we need to be or even six months. And what ends up happening is people end up getting cleared from physical therapy. They get some pamphlet with some exercises that say, do some jumping, do some running, and then you’re on your way. And then they’ll go to the surgeon and they’ve been cleared by physical therapy. And so then the surgeon. Checks them on the table and is like okay, you’re good to go. And then what happens?

They go out and they play a sport that they’re not ready, or they do something that they’re not ready for. And then a re-injury occurs. So how do we fix this? And now there’s so many different ways to go about doing this, and it’s all gonna be specific to you and what resources you have, who you’re working with.

But the first thing I would say is if you have a certain amount of insurance visits, then if you use that nine month timeframe, that is something that you can strategically talk to with your surgeon. And especially with a healthcare professional, if you’re working with a physical therapist, then talk to them and see, this is what I’m aiming for– how can we strategically plan this out? You don’t need to do three visits every single week. And I would argue early in the ACL rehab process, post-op, it is basic. You are attacking range of motion. You’re attacking the swelling. You’re attacking the quadricep activation. Now you need guidance there, but there is even research to show that some of the remote stuff and telehealth work. People still get similar outcomes without having to physically come into the clinic.

Now, if you’re not accountable, and you’re not motivated to get things done, then that might be a different conversation. But for most people that I work with, they end up being self motivated through this process, because they want to get back to a sport or they want to play with their kids or some sort of activity.

So they’re motivated to make sure that they get the changes that they want. And I would argue that having a coach in the mid to later stages of ACL recovery is more important. You’re working on building as much strength as you possibly can, but then now you’re moving towards the on-field rehab where a good coach’s eye to see where is that knee at, in its position? Are there any compensations, doing the testing that is needed for that stuff. Because that’s the stuff that is more taxing and you need someone to help guide you along the process that is more difficult and creating more exposure for you.

And if there’s not as much comfort for the physical therapist to do this part of the recovery, then referring out to your network of trainers and coaches can be of so much benefit. And I would argue that strength coaches are just fab for this part of the process for ACL rehab, or if you want to call it ACL training.

This is the on-field, this is their bread and butter stuff. So if you have relationships, that might be a benefit to be able to find someone who can do that and team up with them. You can also see if the physical therapist that you’re working with offers a hybrid style approach of maybe some in person sessions and some online sessions.

Or maybe you don’t have the resources or the time to be able to go in person all the time. So then you do a complete virtual. So there are different opportunities to do that. And for me, I have a mix of people who are in person and virtual as well as I work with athletes who are recovering from ACL injuries who are completely virtual and is very doable without ever seeing them. They still do really well. The main goal is to have clear communication and the expectations with this process. We use video for feedback and that would be no different if I was in person or if it’s virtual. Those are things that we consistently use because it allows us to have information, to be able to guide this process along.

So try to find a way to maximize your ACL recovery. And at the end of the day, you have the power to decide because it’s your care. It’s your ACL recovery. That doesn’t mean you don’t listen to the surgeon or the physical therapist or your athletic trainer. Whoever you’re working with, you want to make sure it’s a team approach and that you’re on the same page with them, but maybe it’s worth having that conversation initially and making sure that you can get the best out of your care. And that will make such a huge difference in your ACL recovery. 

All right guys. So that’s it for this episode, short and sweet insurance healthcare and how that could be strategized differently for you. If you are recovering in this process, or if you’re working with someone in this process, maybe it’s a different way to think about it, but as always, thank you all so much for listening to the ACL athlete podcast.