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Status:Closed    Asked:Oct 04, 2013 - 11:52 AM

How can my planned business for special needs members be insurance reimbursable? (Mental Health & Elderly)

I am planning to work with special needs children, adults with emotional issues, and the elderly. I have a great deal of experience with these populations and the focus of getting certified was to help eleviate anxiety and depression while increasing overall health, but these populations rely almost solely on medicaid/medicare for health care.

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Unless you’re a state-licensed health care provider in addition to being a certified fitness professional, the odds of receiving 3rd-party reimbursement for fitness services are pretty low. Louisiana is the only state the licenses exercise physiologists, and there are no states licensing any other type of fitness professional.

Medicaid and Medicare reimburse only for specific services ordered by a licensed health care professional (such as an MD, ND, DO, ARNP, or PA-C) and administered by a licensed health care provider (such as an RN, RPT, RD, or OT).
Even certified fitness professionals employed by medical centers or clinics aren’t considered providers by Medicare or Medicaid, and the same is true for private insurance companies. Exercise physiologists or fitness specialists may be part of a cardiac rehabilitation care team, but employers can’t bill Medicare or Medicaid — or any 3rd party — specifically for their services.

Many private insurers offer their members a certain amount of reimbursement for fitness-related expenses like gym membership, but I’m not aware of any reimbursing for personal training fees.

You are doing such important work in serving these special-needs populations. In the future, insurance providers may recognize fitness professionals as an integral part of the health-care team in providing preventive and rehabilitative services, but for now, they don’t.

If you haven’t already, you might check into non-profit organizations and foundations serving these populations to see if any funds are available to develop group exercise programs. You could also check with the National Center on Health, Physical Activity, and Disability; they may be aware of additional resources.



Oct 04, 2013 - 11:52 AM

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