Sports Med clinics, rotator cuffs, and alberta blue cross

[TimG]

I'm pretty sure that i injured my rotator cuff. if i bypass going to the drop-in clinic and go straight to a sports med clinic that can get an MRI and physio started right away will it be covered under the provincial health plan?

I think in ontario you had to be refered to such a place by a GP in order for it to be covered under the province's health plan.

btw, is the sports med place at Eau Claire any good?

[~Leah~]

Pretty sure you need to be referred here as well but I could be wrong.

[xrayvsn]

To get the MRI you will have to get on the waiting list, unless you go to a private MR and pay for it yourself, in which case you can get in within a week. You will need a referral from your doctor for the MR in both cases.

[TimG]

what are wait time like in calgary to get an MRI?

[xrayvsn]

Not sure about Calgary - there is a waitlist registry that you can search the different services, including MRI:

http://www.ahw.gov.ab.ca/waitlist/WaitListPublicHome.jsp


Edit: For a suspected rotator cuff tear, you will probably be put into Urgency level 2. For Calgary, this is what I found:

http://www.ahw.gov.ab.ca/waitlist/AccessGoalCharts.jsp?rcatID=18&rhaID=23_&doSearch=true&urgencyCode=2

90% means that 9/10 at this urgency level get their scan within the timeframe of the darker blue line. In April, looks like this is within 7 weeks. The light blue is the target waitlist time.

[00redLUDE]

Originally posted by TimG
I'm pretty sure that i injured my rotator cuff. if i bypass going to the drop-in clinic and go straight to a sports med clinic that can get an MRI and physio started right away will it be covered under the provincial health plan?

I think in ontario you had to be refered to such a place by a GP in order for it to be covered under the province's health plan.

btw, is the sports med place at Eau Claire any good?

You have a few things in your statement. First, you do not need to get a referral to goto physio you can just call them and make your own appointment. IF you have a drug plan that covers for physio, then you need to see a medical doctor and get a rx for physio before your drug plan will cover it.

Second, if you want to see a sports medicine doctor (MD) then you will need a referral from another medical doctor to see the sports medicine doctor.

Third, MRI if you go through the public system you will need a referral from a medical doctor and the wait time right now is about 3-6months. If you want to go through the private system you will STILL need a referral from a medical doctor but you would be able to get one in 1-2weeks. The cost is about $500-800.

The referral to a sport medicine doctor and MRI through the public system is covered under Alberta Health Care. The physio and private MRI is NOT covered under Alberta Health Care.

That should answer your questions. However, the more important question is why you think you have a rotator cuff injury? Here are my questions for you. What was the nature of the injury? Are you having pain or difficulty in a particular range of motion eg. pain or decrease abduction of your shoulder? Is the pain along the shoulder joint line or somewhere else? Do you have any bone pain or pain in the AC joint?

If you do have a rotator cuff injury then there is only really two treatment courses; conservative or surgical. You always start with conservative no matter how severe the rotator cuff injury, which means heat, ROM, medications, physio. If that doesn't work then a MRI would be useful to assess the extent of the injury and confirm that it IS a rotator cuff injury and then surgical consult may be looked at, at that point in time.

[xrayvsn]

:werd: What he said.

[TrevorK]

Originally posted by 00redLUDE
Second, if you want to see a sports medicine doctor (MD) then you will need a referral from another medical doctor to see the sports medicine doctor.


I saw Dr Randy Gregg without a referral. I just called up, made an appointment.



The referral to a sport medicine doctor and MRI through the public system is covered under Alberta Health Care. The physio and private MRI is NOT covered under Alberta Health Care.

For Physio Alberta Health Care will cover the initial consultation and two treatments. Last year it was six treatments they covered, but they changed it due to abuse.

This was the way it was when I went last year.

[xrayvsn]

Originally posted by TrevorK


I saw Dr Randy Gregg without a referral. I just called up, made an appointment.


He is a general practitioner who has a sports medicine practice. You do not need a referral to see Dr Gregg, since he is still considered a family doctor. If you wanted to see an orthopedic surgeon, you will need a referral from your GP. If you need any imaging tests done (MRI, joint injections, shoulder fluoroscopy, or ultrasound) you need a referral.

[00redLUDE]

Originally posted by TrevorK


I saw Dr Randy Gregg without a referral. I just called up, made an appointment.



https://host.softworks.ca/agate3/client/cpsa/custom/findaphysician/medical_directory.asp

Dr. Gregg is a family physician (general practitioner, GP, FP) with an INTEREST in sports medicine. He did not do any extra training to have the official designation of a sports medicine doctor (see in the approval section comes up N/A) so you do not need a referral to see him.

Now do a search for Dr. Maureen Kennedy and you see in the approval section it states sports medicine. This means that Dr. Kennedy did extra training in sports medicine and has the designation of sports medicine doctor and as such requires a referral from a medical doctor. This is for billing and medical legal purposes.





For Physio Alberta Health Care will cover the initial consultation and two treatments. Last year it was six treatments they covered, but they changed it due to abuse.

This was the way it was when I went last year.

What Alberta Health Care is covering in terms of physio has been changing over the last few years. There was a time that everyone got physio coverage up to a certain amount then you would have to pay after that. Then they changed it so that each physio clinic would get a certain financial allotment each month from Alberta Health Care for them to determine who would pay or how they would determine how to use that allotment. There is talk that Alberta Health Care is going to be withdrawing physio coverage but I am not completely sure on this point. Physio clinics are now depending more on third party coverage than Alberta Health Care. Nevertheless, your best bet is to call a physio clinic and inquire exactly what there billing policies are. Until then I believe my comments regarding physio and Alberta Health Care would be the most conservative one.

[TrevorK]

Originally posted by 00redLUDE


https://host.softworks.ca/agate3/client/cpsa/custom/findaphysician/medical_directory.asp

Dr. Gregg is a family physician (general practitioner, GP, FP) with an INTEREST in sports medicine. He did not do any extra training to have the official designation of a sports medicine doctor (see in the approval section comes up N/A) so you do not need a referral to see him.

In the Edmonton community he's considered one of the best in terms of sports injuries.

I don't see how you could underestimate a guy who entered med school at 16.



What Alberta Health Care is covering in terms of physio has been changing over the last few years. There was a time that everyone got physio coverage up to a certain amount then you would have to pay after that. Then they changed it so that each physio clinic would get a certain financial allotment each month from Alberta Health Care for them to determine who would pay or how they would determine how to use that allotment. There is talk that Alberta Health Care is going to be withdrawing physio coverage but I am not completely sure on this point. Physio clinics are now depending more on third party coverage than Alberta Health Care. Nevertheless, your best bet is to call a physio clinic and inquire exactly what there billing policies are. Until then I believe my comments regarding physio and Alberta Health Care would be the most conservative one.

WHAT DOES CAPITAL HEALTH COVER?
Beginning in April, 2005, the CRP will cover the client's initial assessment. If the client qualifies for coverage, the program will cover the full cost of up to:

1 - two treatments for regular clients per year (April 1-March 31)
2 - six treatments for low-income clients per year (April 1-March 31)
3 - six treatments for designated orthopedic/surgical clients per year (April 1-March 31)
4 - six treatments for designated neurological clients per year (April 1-March 31)
5 - six treatments for designated incontinence clients per year (April 1 - March 31)
If you need more than the alloted treatments, the extra visits may be covered by other health benefits (see What are my other options?). If you have no other coverage, you can ask your physical therapist to apply to CRP for a review of your case to see if more treatments can be covered.

[xrayvsn]

Originally posted by TrevorK


In the Edmonton community he's considered one of the best in terms of sports injuries.

I don't see how you could underestimate a guy who entered med school at 16.


Dr Gregg is extremely well respected in the medical community. This is not because he entered med school at 16, but because he is good at what he does.

I don't think 00redLUDE was underestimating Dr Gregg in any way. He was merely explaining that Dr Gregg is a General Practitioner by his training, meaning that you can go to see him without having to get a referral. Family doctors have the flexibility that if they do have an interest in a particular field, that they do more of that type of medicine in their practice. For him, this interest is in sports medicine, to the point that his practice is completely composed of sports medicine patients. However, from the eyes of the Royal College of Physicians of Alberta, he is still a family doctor, and does not require a physician referral to see him.

[00redLUDE]

Originally posted by TrevorK


In the Edmonton community he's considered one of the best in terms of sports injuries.

I don't see how you could underestimate a guy who entered med school at 16.

I am not questioning Dr. Gregg's ability as a physician. I am merely pointing out YOUR misunderstanding of why you need a referral from a medical doctor to see a sports medicine doctor and why you don't need a referral to see a family physician with an interest in sports medicine but not college approved designation of such.

BTW I am glad to see you are so knowledgeable with regards to everyone in a community of about 900 000 people that you took a survey and found out the Dr. Gregg is 'considered one of the best in terms of sports injuries.' Just so there is no misunderstanding here, this is sarcasm directed at you and NOT at Dr. Gregg as a physician.



WHAT DOES CAPITAL HEALTH COVER?
Beginning in April, 2005, the CRP will cover the client's initial assessment. If the client qualifies for coverage, the program will cover the full cost of up to:

1 - two treatments for regular clients per year (April 1-March 31)
2 - six treatments for low-income clients per year (April 1-March 31)
3 - six treatments for designated orthopedic/surgical clients per year (April 1-March 31)
4 - six treatments for designated neurological clients per year (April 1-March 31)
5 - six treatments for designated incontinence clients per year (April 1 - March 31)
If you need more than the alloted treatments, the extra visits may be covered by other health benefits (see What are my other options?). If you have no other coverage, you can ask your physical therapist to apply to CRP for a review of your case to see if more treatments can be covered.


Are you referring to the capital health region? Because that is NOT Alberta Health Care. Even in your quote it states 'IF the client qualifies for coverage' Do you have the EXACT information of requirements that would make someone qualify? If not then would you not agree that my statement of contacting the physio clinic and inquiring what their billing policies are would be the most appropriate manner of action?

[TrevorK]

Originally posted by 00redLUDE


I am not questioning Dr. Gregg's ability as a physician. I am merely pointing out YOUR misunderstanding of why you need a referral from a medical doctor to see a sports medicine doctor and why you don't need a referral to see a family physician with an interest in sports medicine but not college approved designation of such.

BTW I am glad to see you are so knowledgeable with regards to everyone in a community of about 900 000 people that you took a survey and found out the Dr. Gregg is 'considered one of the best in terms of sports injuries.' Just so there is no misunderstanding here, this is sarcasm directed at you and NOT at Dr. Gregg as a physician.

All the doctor's I went to for my back problems referred me to Dr. Gregg over any other doctor. So yeah, that carries a bit of weight.





Are you referring to the capital health region? Because that is NOT Alberta Health Care. Even in your quote it states 'IF the client qualifies for coverage' Do you have the EXACT information of requirements that would make someone qualify? If not then would you not agree that my statement of contacting the physio clinic and inquiring what their billing policies are would be the most appropriate manner of action?

WHO QUALIFIES?
To find out if your physical therapy services will be covered by Capital health, call a clinic listed here and make an appointment for a CRP assessment.
A physical therapist will assess the impact your injury or condition has on your daily activities, and the benefit your are likely to get from therapy, to determine whether you qualify for CRP funded treatments. If you don't qualify based on your assessment, you may want to look into your other options, or you can seek a second assessment at another CRP contracted clinic.
CRP physical therapy assessments are available to all Albertans with a valid Alberta Personal Health Number.

My physiotherapist told me that if you have a legimate injury you will not get turned down for the free care.


And yes, you're right. It's the community rehab. program, which isn't Alberta Health Care.

[TimG]

update: i have a torn muscle in my shoulder. yay me. The doctor gave me some non-steroidal anti-inflamatories and an Rx for physio.

So is the physio place at eau claire any good?

[adidas]

The place by eau claire is pretty good.

Alot of the physio therapists know what they are talking about and they treat u very well.

About 2 or so years ago when i went, it was free for the first visit and i was there for about 2 hours. Also they charged $55/hour, it might have changed by now. If you have coverage then you are set!